Maricruz Rivera-Hernandez1, Chanee D Fabius2, Shekinah Fashaw3, Brian Downer4, Amit Kumar5, Orestis A Panagiotou3, Gary Epstein-Lubow6. 1. Department of Health, Services, Policy and Practice at the Brown University School of Public Health, Providence, RI, USA. Electronic address: Maricruz_Rivera-Hernandez@Brown.edu. 2. Bloomberg School of Public Health, Department of Health Policy and Management Johns Hopkins University, Baltimore, MD, USA. 3. Department of Health, Services, Policy and Practice at the Brown University School of Public Health, Providence, RI, USA. 4. Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA. 5. College of Health & Human Services, Northern Arizona University, Flagstaff, AZ, USA. 6. Department of Health, Services, Policy and Practice at the Brown University School of Public Health, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
Abstract
OBJECTIVES: As the number of Hispanics with dementia continues to increase, greater use of post-acute care in nursing home settings will be required. Little is known about the quality of skilled nursing facilities (SNFs) that disproportionately serve Hispanic patients with dementia and whether the quality of SNF care varies by the concentration of Medicare Advantage (MA) patients with dementia admitted to these SNFs. DESIGN: Cross-sectional study using 2016 data from Medicare certified providers. SETTING AND PARTICIPANTS: Our cohort included 177,396 beneficiaries with probable dementia from 8884 SNFs. METHODS: We examined facility-level quality of care among facilities with high and low proportions of Hispanic beneficiaries with probable dementia enrolled in MA and fee-for-service (FFS) using data from Medicare-certified providers. Three facility-level measures were used to assess quality of care: (1) 30-day rehospitalization rate; (2) successful discharge from the facility to the community; and (3) Medicare 5-star quality ratings. RESULTS: About 20% of residents were admitted to 1615 facilities with a resident population that was more than 15% Hispanic. Facilities with a higher share of Hispanic residents had a lower proportion of 4- or 5-star facilities by an average of 14% to 15% compared with facilities with little to no Hispanics. In addition, these facilities had a 1% higher readmission rate. There were also some differences in the quality of facilities with high (>26.5%) and low (<26.5%) proportions of MA beneficiaries. On average, SNFs with a high concentration of MA patients have lower readmission rates and higher successful discharge, but lower star ratings. CONCLUSIONS AND IMPLICATIONS: Achieving better quality of care for people with dementia may require efforts to improve the quality of care among facilities with a high concentration of Hispanic residents.
OBJECTIVES: As the number of Hispanics with dementia continues to increase, greater use of post-acute care in nursing home settings will be required. Little is known about the quality of skilled nursing facilities (SNFs) that disproportionately serve Hispanic patients with dementia and whether the quality of SNF care varies by the concentration of Medicare Advantage (MA) patients with dementia admitted to these SNFs. DESIGN: Cross-sectional study using 2016 data from Medicare certified providers. SETTING AND PARTICIPANTS: Our cohort included 177,396 beneficiaries with probable dementia from 8884 SNFs. METHODS: We examined facility-level quality of care among facilities with high and low proportions of Hispanic beneficiaries with probable dementia enrolled in MA and fee-for-service (FFS) using data from Medicare-certified providers. Three facility-level measures were used to assess quality of care: (1) 30-day rehospitalization rate; (2) successful discharge from the facility to the community; and (3) Medicare 5-star quality ratings. RESULTS: About 20% of residents were admitted to 1615 facilities with a resident population that was more than 15% Hispanic. Facilities with a higher share of Hispanic residents had a lower proportion of 4- or 5-star facilities by an average of 14% to 15% compared with facilities with little to no Hispanics. In addition, these facilities had a 1% higher readmission rate. There were also some differences in the quality of facilities with high (>26.5%) and low (<26.5%) proportions of MA beneficiaries. On average, SNFs with a high concentration of MA patients have lower readmission rates and higher successful discharge, but lower star ratings. CONCLUSIONS AND IMPLICATIONS: Achieving better quality of care for people with dementia may require efforts to improve the quality of care among facilities with a high concentration of Hispanic residents.
Keywords:
Alzheimer's disease and related dementias; post-acute care residents with dementia; quality of care for Hispanics with dementia; quality of skilled nursing facilities
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