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Examining Racial and Ethnic Differences in Nursing Home Quality
Joint Commission Journal on Quality and Patient Safety
|October 24, 2017
Summary
Racial and ethnic disparities in nursing home quality exist within facilities. On average, care was equitable, but significant variations were found, sometimes with white residents experiencing worse outcomes.
Area of Science:
- Gerontology
- Health Services Research
- Health Disparities
Background:
- Identifying racial/ethnic differences in quality is crucial for reducing healthcare disparities.
- While between-nursing home disparities are known, within-facility racial/ethnic quality variations remain understudied.
Purpose of the Study:
- To measure within-facility differences in nursing home quality by race/ethnicity.
- To examine variations in publicly reported quality measures across racial/ethnic groups within the same facility.
Main Methods:
- Utilized resident assessment data from ~15,000 nursing homes and ~3 million residents (2009).
- Assessed eight long-stay quality measures, stratified by race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic).
- Examined within-facility differences for quality measures including weight loss, pressure ulcers, incontinence, and functional decline.
Main Results:
- Found small but significant average differences in care across racial/ethnic groups within facilities.
- Observed unexpected results where white residents sometimes had poorer outcomes than black and Hispanic residents in the same facility.
- Documented a wide range of within-nursing home quality variations by race/ethnicity.
Conclusions:
- On average, nursing home care appears equitable across racial/ethnic groups within the same facility.
- Results support public reporting of stratified nursing home quality measures.
- Nursing home providers should proactively identify and address within-facility racial/ethnic quality differences.
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