Facility and county effects on racial differences in nursing home quality indicators

Area of Science:

• Gerontology and Health Services Research
• Racial Disparities in Healthcare
• Nursing Home Quality of Care

Background:

• Understanding how nursing home (NH) and county-level racial composition influences the quality of care provided is crucial for addressing health equity.
• Quality indicators (QIs) such as restraint and antipsychotic drug use are key metrics for monitoring NH quality, particularly for diverse resident populations.

Purpose of the Study:

• To investigate the association between the racial mix of nursing home residents and county demographics with specific quality of care outcomes.
• To analyze the impact of NH and county racial composition on restraint and antipsychotic drug use among Urban Non-Hispanic Whites and Urban African Americans.

Main Methods:

• Utilized a hierarchical modeling approach to analyze data from 408 urban New York nursing homes (NHs) between July and September 1995.
• Examined quality indicator (QI) outcomes, specifically restraint and antipsychotic drug use, for low and high-risk residents across different racial groups.
• Conducted separate regression analyses for Urban Non-Hispanic Whites and Urban African Americans to assess the effect of higher African American proportions.

Main Results:

• Descriptive analysis revealed lower unadjusted restraint rates but higher antipsychotic drug use among African Americans compared to Whites.
• Multi-level analyses indicated that for-profit NHs and higher proportions of African American residents were associated with increased restraint likelihoods for both racial groups.
• Higher NH nurse staffing ratios were linked to increased restraint likelihoods and decreased antipsychotic drug use, particularly for low-risk African Americans.

Conclusions:

• Findings suggest that nursing homes (NHs) with a higher proportion of African American residents provide differential care, warranting organizational-level interventions.
• The study highlights the need for targeted strategies to improve quality of care outcomes, specifically reducing restraint and antipsychotic drug use, for all resident racial groups.
• Results underscore the importance of considering both NH and broader community racial demographics when evaluating and improving NH quality of care.