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.

Public Health Relevance

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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Minority Health and Health Disparities (NIMHD)
Type
Research Project (R01)
Project #
5R01MD007662-02
Application #
8695480
Study Section
Special Emphasis Panel (ZMD1-MLS (01))
Program Officer
Dankwa-Mullan, Irene
Project Start
2013-07-03
Project End
2017-01-31
Budget Start
2014-02-01
Budget End
2015-01-31
Support Year
2
Fiscal Year
2014
Total Cost
$349,369
Indirect Cost
$79,731
Name
University of Rochester
Department
Public Health & Prev Medicine
Type
Schools of Dentistry
DUNS #
041294109
City
Rochester
State
NY
Country
United States
Zip Code
14627
Campbell, Lauren J; Li, Qinghua; Li, Yue (2014) Healthcare worker influenza vaccination in Oregon nursing homes: correlates of facility characteristics. J Am Med Dir Assoc 15:768-72
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
McGarry, Brian E; Strawderman, Robert L; Li, Yue (2014) The Care Span: Lower Hispanic participation in Medicare Part D may reflect program barriers. Health Aff (Millwood) 33:856-62
Li, Yue; Cai, Xueya (2014) Racial and ethnic disparities in social engagement among US nursing home residents. Med Care 52:314-21