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Are Patients With Serious Mental Illness More Likely to be Admitted to Nursing Homes With More Deficiencies in Care?

Li, Yue, PhD*,†; Cai, Xueya, PhD*,†; Cram, Peter, MD, MBA*,†

doi: 10.1097/MLR.0b013e318202ac10
Original Articles

Background Patients diagnosed with serious mental illness (SMI) who qualify for nursing home placement tend to require high levels of both psychiatric and nursing care. However, it is unknown whether they are equally likely to be admitted to nursing homes with adequate quality of care compared with other patients.

Methods We analyzed a national cohort of more than 1.3 million new nursing home admissions in 2007 using the minimum data set. The total and healthcare-related deficiency citations for each facility were obtained from the Online Survey, Certification, and Reporting file. Bivariate and multivariate regression analyses determined the association of schizophrenia or bipolar disorder with admissions to facilities with higher deficiencies.

Results Compared with other patients, patients with schizophrenia (n=23,767) tended to enter nursing homes with more total (13.3 vs. 11.2, P<0.001) and healthcare-related deficiencies (8.6 vs. 7.2, P<0.001); and patients with bipolar disorder (n=19,741) were more likely to enter facilities with more problematic care too (12.5 vs. 11.2, P<0.001 for total deficiencies; and 8.2 vs. 7.2, P<0.001 for healthcare-related deficiencies). After sequentially controlling for the within-county choice of facilities, patient characteristics, and facility covariates, the association of SMI with admitting to higher-deficiency nursing homes persisted.

Conclusions Patients diagnosed with schizophrenia or bipolar disorder (ie, SMI) were more likely than other patients to be admitted to nursing homes with higher deficiency citations for both overall quality and clinical care quality. Further research is necessary to understand the reasons behind the disparity in quality of nursing home care associated with SMI.

*Division of General Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA

Center for Comprehensive Access & Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa City, IA

This study is supported by the Nation Institute on Aging (NIA) under grant R01 AG032264 (to Y.L.). It is also supported by a K23 career development award (RR01997201) from the NCRR at the NIH and the Robert Wood Johnson Physician Faculty Scholars Program (to P.C.), and by R01 HL085347-01A1 from NHLBI at the NIH.

Reprints: Yue Li, PhD, University of Iowa and Iowa City VAMC, 200 Hawkins Drive, C44-N GH, Iowa City, IA 52242. e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.