Racial/ethnic minorities made up about 16 percent of the nursing home population in 2004. More recent data suggest that the number of minority nursing homes residents is increasing dramatically, while the number of white residents is declining. These new demographic changes raise concerns about whether nursing homes are able to serve appropriately the needs of patients with increasingly diverse ethnic and cultural backgrounds. The quality of care delivered in nursing homes has been a longstanding issue plaguing the industry, and continues to be the focus of federal and state policies aimed at improving it. Extant evidence suggests that these policies, including strengthened state quality regulations, improved Medicaid reimbursements, and more recent efforts to foster market competition (e.g., the repeal of the Certificate of Need requirement;the national quality reporting), have improved nursing home quality and outcomes during the past decade. As the industry makes headway and improves quality in response to these policy and market trends, it is important to recognize that improvements in overall nursing home quality may not automatically benefit all subgroups of patients equally. Indeed, despite evidence of overall improvements, a large body of literature continues to document racial/ethnic disparities in nursing home quality. In particular, our recent work, published in the Journal of American Medical Association, has for the first time provided evidence that while pressure ulcer outcomes in nursing homes have improved for both non-Hispanic whites and minorities, the gap between these two groups of patients remained unchanged. Thus, the overall goal of this proposal is to answer two very important questions: 1) Does this phenomenon, of improvement in quality for all concomitant with a persistent gap between racial/ethnic groups, exist in other areas of known disparities for nursing home care? and 2) Can we identify specific policy and market characteristics that have been successful not only in improving quality but also in closing the racial and ethnic gap in quality? The proposed project will achieve these goals by investigating the longitudinal and cross sectional impact of each of three major types of nursing home quality drivers - state regulation of quality, Medicaid reimbursement, and market competition - on the racial/ethnic quality gap and its persistence. The information generated by this project will contribute to the knowledge regarding the ways with which major nursing home policies impact equity of care.
The proposed project will investigate the longitudinal and cross sectional impact of each of three major types of nursing home quality drivers - state regulation of quality, Medicaid reimbursement, and market competition - on the racial/ethnic quality gap and its persistence.
|Campbell, Lauren J; Cai, Xueya; Gao, Shan et al. (2016) Racial/Ethnic Disparities in Nursing Home Quality of Life Deficiencies, 2001 to 2011. Gerontol Geriatr Med 2:2333721416653561|
|Li, Yue; Li, Qinghua; Tang, Yi (2016) Associations Between Family Ratings on Experience With Care and Clinical Quality-of-Care Measures for Nursing Home Residents. Med Care Res Rev 73:62-84|
|McGarry, Brian E; Temkin-Greener, Helena; Chapman, Benjamin P et al. (2016) The Impact of Consumer Numeracy on the Purchase of Long-Term Care Insurance. Health Serv Res 51:1612-31|
|Mukamel, Dana B; Ladd, Heather; Li, Yue et al. (2015) Have Racial Disparities in Ambulatory Care Sensitive Admissions Abated Over Time? Med Care 53:931-9|
|Li, Yue; Harrington, Charlene; Mukamel, Dana B et al. (2015) Nurse Staffing Hours At Nursing Homes With High Concentrations Of Minority Residents, 2001-11. Health Aff (Millwood) 34:2129-37|
|Mukamel, Dana B; Ye, Zhiqiu; Glance, Laurent G et al. (2015) Does mandating nursing home participation in quality reporting make a difference? Evidence from Massachusetts. Med Care 53:713-9|
|Li, Yue; Harrington, Charlene; Temkin-Greener, Helena et al. (2015) Deficiencies In Care At Nursing Homes And Racial/Ethnic Disparities Across Homes Fell, 2006-11. Health Aff (Millwood) 34:1139-46|
|Li, Yue; Cai, Xueya; Glance, Laurent G (2015) Disparities in 30-Day Rehospitalization Rates Among Medicare Skilled Nursing Facility Residents by Race and Site of Care. Med Care 53:1058-65|
|Campbell, Lauren J; Li, Qinghua; Li, Yue (2015) Does Nursing Home Ownership Change Affect Family Ratings on Experience with Care? J Aging Soc Policy 27:314-30|
|Li, Yue; Ye, Zhiqiu; Glance, Laurent G et al. (2014) Trends in family ratings of experience with care and racial disparities among Maryland nursing homes. Med Care 52:641-8|
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