Wong Andrew M, Braun Robert Tyler
Yale University, New Haven, CT, USA.
Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
J Am Med Dir Assoc. 2024 Oct;25(10):105174. doi: 10.1016/j.jamda.2024.105174. Epub 2024 Jul 28.
To examine if the quality of care in Appalachian nursing homes in metropolitan, micropolitan, and rural areas differs from those in non-Appalachian regions of the United States.
Retrospective analysis of Medicare Cost Reports, combined with data from Nursing Home Compare, LTCFocus, and Medicare, Post-Acute Care, and Hospice Public Use Form. Nursing homes were classified using Rural-Urban Commuting Area Codes.
Data from 14,040 nursing homes reporting on staffing, costs, and quality of care metrics from 2013 to 2019 were analyzed.
Descriptive analyses compared resident and facility characteristics, quality, staffing, and cost outcomes between non-Appalachian and Appalachian nursing homes in metropolitan, micropolitan, and rural areas. Regressions compared quality, staffing, and cost outcomes among (1) Appalachian metropolitan and non-Appalachian nursing homes, (2) Appalachian micropolitan and non-Appalachian nursing homes, and (3) Appalachian rural and non-Appalachian nursing homes. Outcomes included health deficiency index scores, Medicare spending per beneficiary, staffing hours per resident day (registered nurse, licensed practical nurse, certified nursing assistant per resident day), and 5 Minimum Data Set metrics for short-stay and long-stay residents.
Appalachian nursing homes are more likely to be hospital-based, for-profit, multifacility chain affiliated, and have higher proportions of white and Medicaid residents. Regression analyses revealed that Appalachian metropolitan nursing homes have 3.3% fewer certified nursing assistant hours per resident day, a 16.5% higher health deficiency score index, and 4.2% higher Medicare spending per beneficiary compared with non-Appalachian homes. Appalachian micropolitan nursing homes showed 7.4% fewer registered nurse hours per resident day and 6.9% higher Medicare spending per beneficiary. Appalachian rural nursing homes had 16.7% more registered nurse hours per resident day, 22.7% lower health deficiency index scores, and 10.7% higher Medicare spending per beneficiary. Minimum Data Set measures varied, with Appalachian nursing homes performing better on some metrics and worse on others.
Appalachia lags behind in staffing and Medicare spending per beneficiary. These disparities should be considered by policymakers advocating for Appalachia's senior citizens.
研究美国大都市、微型都市和农村地区阿巴拉契亚地区疗养院的护理质量是否与非阿巴拉契亚地区不同。
对医疗保险成本报告进行回顾性分析，并结合来自疗养院比较、长期护理焦点以及医疗保险、急性后护理和临终关怀公共使用表格的数据。疗养院使用城乡通勤区号进行分类。
分析了2013年至2019年期间14,040家报告人员配备、成本和护理质量指标的疗养院的数据。
描述性分析比较了大都市、微型都市和农村地区非阿巴拉契亚和阿巴拉契亚疗养院之间的居民和机构特征、质量、人员配备和成本结果。回归分析比较了（1）阿巴拉契亚大都市和非阿巴拉契亚疗养院、（2）阿巴拉契亚微型都市和非阿巴拉契亚疗养院以及（3）阿巴拉契亚农村和非阿巴拉契亚疗养院之间的质量、人员配备和成本结果。结果包括健康缺陷指数得分、每位受益人的医疗保险支出、每位居民每天的人员配备小时数（注册护士、执业护士、认证护理助理每位居民每天的小时数）以及短期和长期居民的5项最低数据集指标。
阿巴拉契亚疗养院更有可能以医院为基础、营利性、隶属于多机构连锁，并且白人和医疗补助居民的比例更高。回归分析显示，与非阿巴拉契亚疗养院相比，阿巴拉契亚大都市疗养院每位居民每天的认证护理助理小时数少3.3%，健康缺陷得分指数高16.5%，每位受益人的医疗保险支出高4.2%。阿巴拉契亚微型都市疗养院每位居民每天的注册护士小时数少7.4%，每位受益人的医疗保险支出高6.9%。阿巴拉契亚农村疗养院每位居民每天的注册护士小时数多16.7%，健康缺陷指数得分低22.7%，每位受益人的医疗保险支出高10.7%。最低数据集指标各不相同，阿巴拉契亚疗养院在某些指标上表现较好，而在其他指标上表现较差。
阿巴拉契亚地区在人员配备和每位受益人的医疗保险支出方面落后。倡导为阿巴拉契亚地区老年人服务的政策制定者应考虑这些差异。
