Objective: The occurrence of pressure ulcers (PUs) in nursing homes is a marker for poor quality of care. We examine whether differences in PU prevalence between black and white residents are due to within- or across-facility disparities.
Methods: Minimum Data Sets (2006–2007) are linked with the Online Survey Certification and Reporting database. Long-term care residents with high risk for PUs are identified. The dependent variable is dichotomous, indicating PU presence/absence. Individual race and facility race-mix are the main variables of interests.
The sample includes 59,740 long-term care high-risk residents (17.4% black and 82.6% white) in 619 nursing homes. We fit 3 risk-adjusted logit models: base, conditional fixed-effects, and random-effects.
Results: Unadjusted PU prevalence is 14.5% (18.2% for blacks and 13.8% for whites). Overall, blacks are more likely to have PUs than whites, controlling for individual risk factors. We find no such effect within facilities after additional accounting for facility fixed effects. The effect of race is significantly different between the base and the conditional fixed-effects logit model. The random-effects and conditional fixed-effects logit models show similar results, demonstrating that higher PU presence among blacks is associated with greater facility-specific concentration of black residents.
Conclusion: Greater PU occurrence among blacks may not result from differential within-facility treatment of blacks versus whites. Rather, blacks are more likely to reside in facilities with poorer care quality. To improve PU care for blacks, efforts should focus on improving the overall quality of care for facilities with high proportion of black residents.
From the *Center for Gerontology and Health Care Research, The Warren Alpert Medical School, Brown University, Providence, RI, †Department of Medicine, Health Policy Research Institute, University of California, Irvine, CA; and ‡Department of Community and Preventive Medicine, University of Rochester School of Medicine, Rochester, NY.
Supported by the National Institute on Aging, (grant R01 AG23077).
Presented at AcademyHealth Annual Meeting 2009 Chicago and APHA 2009 Philadelphia.
This study does not have any potential conflicts of interest in the past 3 years.
Reprints: Shubing Cai, PhD, Center for Gerontology and Health Care Research, The Warren Alpert Medical School, Brown University, 121 South Main Street, Providence, RI 02912. E-mail: Shubing_Cai@brown.edu.edu.