Using individual level data on all residents of all U.S. nursing homes in five states collected for the Health Care Financing Administration (HCFA) Multistate Nursing Home Case-mix and Quality Demonstration Project, we have noted in our prescribing trends studies that minority residents are less likely to receive medically appropriate treatments. We have also recently examined racial/ethnic disparities in U.S. nursing home care, and have preliminary evidence to suggest that, in fact, minority elders do not receive care of comparable quality to whites, controlling for differences in severity of conditions, socio-economic status and patient preference. Although we have considered race/ethnicity as an independent variable in analyses conducted for different purposes, we have yet to systematically review disparities by race/ethnicity in the receipt of medications. Identifying the extent to which individual factors may explain the disturbing trends evaluated thus far is essential to our understanding. Regardless we have very little understanding of how these racial/ethnic disparities are influenced by organizational structures (specifically. facility size, ownership, system-affiliation, and staffing patterns). Using data collected from 1992-1997 including information on all Medicare/Medicaid recipients in 2,040 nursing homes in six states (New York, Mississippi, South Dakota, Kansas, Ohio, and Maine), we will focus on newly admitted residents at least 65 years of age with conditions for which pharmacologic therapy is available. We will explore hypotheses regarding mechanisms to explain observed disparities. In particular, we are concerned that any racial/ethnic differences observed may not be fully explained by racial/ethnic differences in severity of conditions, patient preference, or social class. As suggested in the literature, provider care may be influenced by subtle or blatant forms of racial discrimination. Thus, we have selected conditions that are reflective of available treatments for which risk to benefit considerations may be non-differential with respect to race/ethnicity and also, that are unlikely to be differentially rejected by racial/ethnic minorities because of personal preferences.
The specific aims of this study are 1) to quantify racial/ethnic differences in the receipt of medications for chronic conditions that may disproportionately affect people of color; 2) To characterize the extent to which the disparities in receipt of medications by race/ethnicity is modified by organizational (e.g. ownership, level of skilled nursing staff, involvement of physicians) and contextual (e.g. market size, urban/rural, county racial/ethnic mix, average income county education level, income inequality); 3) To quantify the effect of race/ethnicity on improvements in pharmacotherapy of chronic conditions among residents living in long term care; and 4) To determine the """"""""consequences"""""""" by race/ethnicity of sub-optimal treatment of chronic conditions among residents of long term care in the form of higher re-hospitalization rates.
