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Persistent geographic variations in availability and quality of nursing home care in the United States: 1996 to 2016
BACKGROUND: Availability of nursing home care has declined and national efforts have been initiated to improve the quality of nursing home care in the U.S. Yet, data are limited on whether there are geographic variations in declines of availability and quality of nursing home care, and whether varia...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460800/ https://www.ncbi.nlm.nih.gov/pubmed/30975076 http://dx.doi.org/10.1186/s12877-019-1117-z |
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author | Wang, Yun Zhang, Qiuli Spatz, Erica S. Gao, Yan Eckenrode, Sheila Johnson, Florence Ho, Shih-Yieh Hu, Shuang Xing, Chao Krumholz, Harlan M. |
author_facet | Wang, Yun Zhang, Qiuli Spatz, Erica S. Gao, Yan Eckenrode, Sheila Johnson, Florence Ho, Shih-Yieh Hu, Shuang Xing, Chao Krumholz, Harlan M. |
author_sort | Wang, Yun |
collection | PubMed |
description | BACKGROUND: Availability of nursing home care has declined and national efforts have been initiated to improve the quality of nursing home care in the U.S. Yet, data are limited on whether there are geographic variations in declines of availability and quality of nursing home care, and whether variations persist over time. We sought to assess geographic variation in availability and quality of nursing home care. METHODS: Retrospective study using Medicaid/Medicare-certified nursing home data from the Centers for Medicare & Medicaid Services, 1996–2016. Outcomes were 1) availability of all nursing home care (1996–2016), measured by the number of Medicaid/Medicare-certified beds for a given county per 100,000 population aged ≥65 years, regardless of nursing home star rating; 2) availability of 5-star nursing home care, measured by the number of Medicaid/Medicare-certified beds provided by 5-star nursing homes; and 3) utilization of nursing home beds, defined as the rate of occupied Medicaid/Medicare-certified beds among the total Medicaid/Medicare-certified beds. RESULTS: From 1999 to 2016, availability of all nursing home care declined from 4882 (standard deviation: 931) to 3480 (912) beds, per 100,000 population aged ≥65 years. Persistent geographic variation in availability of nursing home care was observed; the correlation coefficient of county-specific availabilities from 1996 to 2016 was 0.78 (95% CI 0.77–0.79). From 2011 to 2016, availability of 5-star nursing home beds increased from 658 (303) to 895 (661) per 100,000 population aged ≥65 years. The correlation coefficient for county-specific availabilities from 2011 to 2016 was 0.54 (95% CI 0.51–0.56). Availability and quality of nursing home care were not highly correlated. In 2016, the correlation coefficient for county-specific availabilities between all nursing home and 5-star nursing home beds was 0.33 (95% CI 0.30–0.36). From 1996 to 2016, the utilization of certified beds declined from 78.5 to 72.2%. This decline was consistent across all census divisions, but most pronounced in the Mountain division and less in the South-Atlantic division. CONCLUSION: We observed persistent geographic variations in availability and quality of nursing home care. Availability of all nursing home care declined but availability of 5-star nursing home care increased. Availability and quality of nursing home care were not highly correlated. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12877-019-1117-z) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6460800 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-64608002019-05-01 Persistent geographic variations in availability and quality of nursing home care in the United States: 1996 to 2016 Wang, Yun Zhang, Qiuli Spatz, Erica S. Gao, Yan Eckenrode, Sheila Johnson, Florence Ho, Shih-Yieh Hu, Shuang Xing, Chao Krumholz, Harlan M. BMC Geriatr Research Article BACKGROUND: Availability of nursing home care has declined and national efforts have been initiated to improve the quality of nursing home care in the U.S. Yet, data are limited on whether there are geographic variations in declines of availability and quality of nursing home care, and whether variations persist over time. We sought to assess geographic variation in availability and quality of nursing home care. METHODS: Retrospective study using Medicaid/Medicare-certified nursing home data from the Centers for Medicare & Medicaid Services, 1996–2016. Outcomes were 1) availability of all nursing home care (1996–2016), measured by the number of Medicaid/Medicare-certified beds for a given county per 100,000 population aged ≥65 years, regardless of nursing home star rating; 2) availability of 5-star nursing home care, measured by the number of Medicaid/Medicare-certified beds provided by 5-star nursing homes; and 3) utilization of nursing home beds, defined as the rate of occupied Medicaid/Medicare-certified beds among the total Medicaid/Medicare-certified beds. RESULTS: From 1999 to 2016, availability of all nursing home care declined from 4882 (standard deviation: 931) to 3480 (912) beds, per 100,000 population aged ≥65 years. Persistent geographic variation in availability of nursing home care was observed; the correlation coefficient of county-specific availabilities from 1996 to 2016 was 0.78 (95% CI 0.77–0.79). From 2011 to 2016, availability of 5-star nursing home beds increased from 658 (303) to 895 (661) per 100,000 population aged ≥65 years. The correlation coefficient for county-specific availabilities from 2011 to 2016 was 0.54 (95% CI 0.51–0.56). Availability and quality of nursing home care were not highly correlated. In 2016, the correlation coefficient for county-specific availabilities between all nursing home and 5-star nursing home beds was 0.33 (95% CI 0.30–0.36). From 1996 to 2016, the utilization of certified beds declined from 78.5 to 72.2%. This decline was consistent across all census divisions, but most pronounced in the Mountain division and less in the South-Atlantic division. CONCLUSION: We observed persistent geographic variations in availability and quality of nursing home care. Availability of all nursing home care declined but availability of 5-star nursing home care increased. Availability and quality of nursing home care were not highly correlated. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12877-019-1117-z) contains supplementary material, which is available to authorized users. BioMed Central 2019-04-11 /pmc/articles/PMC6460800/ /pubmed/30975076 http://dx.doi.org/10.1186/s12877-019-1117-z Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Wang, Yun Zhang, Qiuli Spatz, Erica S. Gao, Yan Eckenrode, Sheila Johnson, Florence Ho, Shih-Yieh Hu, Shuang Xing, Chao Krumholz, Harlan M. Persistent geographic variations in availability and quality of nursing home care in the United States: 1996 to 2016 |
title | Persistent geographic variations in availability and quality of nursing home care in the United States: 1996 to 2016 |
title_full | Persistent geographic variations in availability and quality of nursing home care in the United States: 1996 to 2016 |
title_fullStr | Persistent geographic variations in availability and quality of nursing home care in the United States: 1996 to 2016 |
title_full_unstemmed | Persistent geographic variations in availability and quality of nursing home care in the United States: 1996 to 2016 |
title_short | Persistent geographic variations in availability and quality of nursing home care in the United States: 1996 to 2016 |
title_sort | persistent geographic variations in availability and quality of nursing home care in the united states: 1996 to 2016 |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6460800/ https://www.ncbi.nlm.nih.gov/pubmed/30975076 http://dx.doi.org/10.1186/s12877-019-1117-z |
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