OBJECTIVE: Explore within and across nursing home (NH) racial disparities in end-of-life (EOL) hospitalizations for residents with Alzheimer's disease or related dementia (ADRD), and examine whether severe cognitive impairment influences these relationships. DESIGN: Observational study merging, at the individual level, C2014-2017 national-level Minimum Data Set (MDS), Medicare Beneficiary Summary Files (MBSF), and Medicare Provider Analysis and Review (MedPAR). Nursing Home Compare (NHC) was also used. SETTING: Long-stay residents who died in a NH or a hospital within 8 days of discharge. PARTICIPANTS: Analytical sample included 665,033 decedent residents with ADRD in 14,595 facilities. MAIN OUTCOMES AND MEASURES: The outcome was hospitalization within 30 days of death. Key independent variables were race, severe cognitive impairment, and NH-level proportion of black residents. Other covariates included socio-demographics, dual eligibility, hospice enrollment, and chronic conditions. Facility-level characteristics were also included (e.g. profit status, staffing hours, etc.). We fit linear probability models with robust standard errors, fixed and random effects. RESULTS: Compared to whites, black decedents had a significantly (p < 0.01) higher risk of EOL hospitalizations (7.88%). Among those with severe cognitive impairment, whites showed a lower risk of hospitalizations (6.04%). But EOL hospitalization risk among blacks with severe cognitive impairment was still significantly elevated (β = 0.0494; p < 0.01). A comparison of the base model with the fixed and random-effects models showed statistically significant hospitalization risk by decedent's race both within and across facilities. CONCLUSIONS AND RELEVANCE: We found disparities between black and white residents with ADRD both within and across facilities. The within-facility disparities may be due to residents' preferences and/or NH practices that contribute to differential treatment. The across facility differences point to the overall quality of care disparities in homes with a higher prevalence of black residents. Persistence of such systemic disparities among the most vulnerable individuals is extremely troubling.
OBJECTIVE: Explore within and across nursing home (NH) racial disparities in end-of-life (EOL) hospitalizations for residents with Alzheimer's disease or related dementia (ADRD), and examine whether severe cognitive impairment influences these relationships. DESIGN: Observational study merging, at the individual level, C2014-2017 national-level Minimum Data Set (MDS), Medicare Beneficiary Summary Files (MBSF), and Medicare Provider Analysis and Review (MedPAR). Nursing Home Compare (NHC) was also used. SETTING: Long-stay residents who died in a NH or a hospital within 8 days of discharge. PARTICIPANTS: Analytical sample included 665,033 decedent residents with ADRD in 14,595 facilities. MAIN OUTCOMES AND MEASURES: The outcome was hospitalization within 30 days of death. Key independent variables were race, severe cognitive impairment, and NH-level proportion of black residents. Other covariates included socio-demographics, dual eligibility, hospice enrollment, and chronic conditions. Facility-level characteristics were also included (e.g. profit status, staffing hours, etc.). We fit linear probability models with robust standard errors, fixed and random effects. RESULTS: Compared to whites, black decedents had a significantly (p < 0.01) higher risk of EOL hospitalizations (7.88%). Among those with severe cognitive impairment, whites showed a lower risk of hospitalizations (6.04%). But EOL hospitalization risk among blacks with severe cognitive impairment was still significantly elevated (β = 0.0494; p < 0.01). A comparison of the base model with the fixed and random-effects models showed statistically significant hospitalization risk by decedent's race both within and across facilities. CONCLUSIONS AND RELEVANCE: We found disparities between black and white residents with ADRD both within and across facilities. The within-facility disparities may be due to residents' preferences and/or NH practices that contribute to differential treatment. The across facility differences point to the overall quality of care disparities in homes with a higher prevalence of black residents. Persistence of such systemic disparities among the most vulnerable individuals is extremely troubling.
Authors: Ana Tuya Fulton; Jennifer Rhodes-Kropf; Amy M Corcoran; Diane Chau; Elizabeth Herskovits Castillo Journal: Clin Geriatr Med Date: 2011-05 Impact factor: 3.076
Authors: Ellen P McCarthy; Jessica A Ogarek; Lacey Loomer; Pedro L Gozalo; Vincent Mor; Mary Beth Hamel; Susan L Mitchell Journal: JAMA Intern Med Date: 2020-03-01 Impact factor: 21.873
Authors: Pei-Jung Lin; Yingying Zhu; Natalia Olchanski; Joshua T Cohen; Peter J Neumann; Jessica D Faul; Howard M Fillit; Karen M Freund Journal: JAMA Netw Open Date: 2022-06-01
Authors: Caroline P Thirukumaran; Benjamin F Ricciardi; Xueya Cai; Robert G Holloway; Yue Li; Laurent G Glance Journal: JAMA Health Forum Date: 2022-02-11