Rohit Pradhan, Justin Lord, Gregory Orewa, Ganisher Davlyatov, Robert Weech-Maldonado
{"title":"社区社会剥夺如何与养老院质量相关：一个结构、过程、结果模型。","authors":"Rohit Pradhan, Justin Lord, Gregory Orewa, Ganisher Davlyatov, Robert Weech-Maldonado","doi":"10.1093/geroni/igaf004","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Nursing home (NH) quality often varies across socioeconomic gradients. The purpose of this study was to explore the relationship between social deprivation and NH quality.</p><p><strong>Research design and methods: </strong>Integrating resource dependence theory with Donabedian's structure-process-outcome model, this study utilized 2019 data from Payroll Based Journal, Care Compare: Five-Star Quality Rating System, and LTCFocus.org. The analytic file included 12,900 free-standing NH observations. The primary variable of interest was severe social deprivation index (SDI) defined as SDI ≥85/100. Structural equation modeling was used to explore the effects of severe deprivation on NH structural (nursing staff), processes (antipsychotic medications [APMs]), and outcomes (falls, pressure ulcers, activities of daily living [ADL] decline, and hospitalizations) quality indicators among long-stay NH residents.</p><p><strong>Results: </strong>Nursing homes in communities with severe SDI showed a decrease of 0.02 registered nurse (RN) hours per resident day (PRD) (<i>p</i> < .001) and an increase of 0.03 certified nursing assistant (CNA) hours PRD (<i>p</i> = .01). Higher licensed practical nurse (LPN) hours PRD (β = -1.03; <i>p</i> = .003) and higher CNA hours PRD (β = -0.80; <i>p</i> < .001) were significantly associated with reduced APM use. Increased APM use was significantly associated with ADL decline (β = 0.03; <i>p</i> < .001) and hospitalizations (β = 0.001; <i>p</i> = .013). Severe SDI indirectly resulted in higher hospitalizations (β = 0.01; <i>p</i> = .01) and falls (β = 0.01; <i>p</i> = .001) through lower RN staffing but lower pressure ulcers (β = -0.07; <i>p</i> < .001) through higher CNA staffing. Directly, severe SDI increased pressure ulcers (β = 0.69; <i>p</i> < .001) and hospitalizations (β = 0.09; <i>p</i> < .001) and decreased falls (β = -0.53; <i>p</i> < .001).</p><p><strong>Discussion and implications: </strong>Severe social deprivation affected nursing staff patterns, affecting care quality. These findings highlight the importance of considering environmental factors in the NH quality policymaking process.</p>","PeriodicalId":13596,"journal":{"name":"Innovation in Aging","volume":"9 2","pages":"igaf004"},"PeriodicalIF":4.9000,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831227/pdf/","citationCount":"0","resultStr":"{\"title\":\"How Neighborhood Social Deprivation Is Associated With Nursing Home Quality: A Structure, Process, Outcome Model.\",\"authors\":\"Rohit Pradhan, Justin Lord, Gregory Orewa, Ganisher Davlyatov, Robert Weech-Maldonado\",\"doi\":\"10.1093/geroni/igaf004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>Nursing home (NH) quality often varies across socioeconomic gradients. The purpose of this study was to explore the relationship between social deprivation and NH quality.</p><p><strong>Research design and methods: </strong>Integrating resource dependence theory with Donabedian's structure-process-outcome model, this study utilized 2019 data from Payroll Based Journal, Care Compare: Five-Star Quality Rating System, and LTCFocus.org. The analytic file included 12,900 free-standing NH observations. The primary variable of interest was severe social deprivation index (SDI) defined as SDI ≥85/100. Structural equation modeling was used to explore the effects of severe deprivation on NH structural (nursing staff), processes (antipsychotic medications [APMs]), and outcomes (falls, pressure ulcers, activities of daily living [ADL] decline, and hospitalizations) quality indicators among long-stay NH residents.</p><p><strong>Results: </strong>Nursing homes in communities with severe SDI showed a decrease of 0.02 registered nurse (RN) hours per resident day (PRD) (<i>p</i> < .001) and an increase of 0.03 certified nursing assistant (CNA) hours PRD (<i>p</i> = .01). Higher licensed practical nurse (LPN) hours PRD (β = -1.03; <i>p</i> = .003) and higher CNA hours PRD (β = -0.80; <i>p</i> < .001) were significantly associated with reduced APM use. Increased APM use was significantly associated with ADL decline (β = 0.03; <i>p</i> < .001) and hospitalizations (β = 0.001; <i>p</i> = .013). Severe SDI indirectly resulted in higher hospitalizations (β = 0.01; <i>p</i> = .01) and falls (β = 0.01; <i>p</i> = .001) through lower RN staffing but lower pressure ulcers (β = -0.07; <i>p</i> < .001) through higher CNA staffing. Directly, severe SDI increased pressure ulcers (β = 0.69; <i>p</i> < .001) and hospitalizations (β = 0.09; <i>p</i> < .001) and decreased falls (β = -0.53; <i>p</i> < .001).</p><p><strong>Discussion and implications: </strong>Severe social deprivation affected nursing staff patterns, affecting care quality. These findings highlight the importance of considering environmental factors in the NH quality policymaking process.</p>\",\"PeriodicalId\":13596,\"journal\":{\"name\":\"Innovation in Aging\",\"volume\":\"9 2\",\"pages\":\"igaf004\"},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2025-01-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11831227/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Innovation in Aging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/geroni/igaf004\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Innovation in Aging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/geroni/igaf004","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
How Neighborhood Social Deprivation Is Associated With Nursing Home Quality: A Structure, Process, Outcome Model.
Background and objectives: Nursing home (NH) quality often varies across socioeconomic gradients. The purpose of this study was to explore the relationship between social deprivation and NH quality.
Research design and methods: Integrating resource dependence theory with Donabedian's structure-process-outcome model, this study utilized 2019 data from Payroll Based Journal, Care Compare: Five-Star Quality Rating System, and LTCFocus.org. The analytic file included 12,900 free-standing NH observations. The primary variable of interest was severe social deprivation index (SDI) defined as SDI ≥85/100. Structural equation modeling was used to explore the effects of severe deprivation on NH structural (nursing staff), processes (antipsychotic medications [APMs]), and outcomes (falls, pressure ulcers, activities of daily living [ADL] decline, and hospitalizations) quality indicators among long-stay NH residents.
Results: Nursing homes in communities with severe SDI showed a decrease of 0.02 registered nurse (RN) hours per resident day (PRD) (p < .001) and an increase of 0.03 certified nursing assistant (CNA) hours PRD (p = .01). Higher licensed practical nurse (LPN) hours PRD (β = -1.03; p = .003) and higher CNA hours PRD (β = -0.80; p < .001) were significantly associated with reduced APM use. Increased APM use was significantly associated with ADL decline (β = 0.03; p < .001) and hospitalizations (β = 0.001; p = .013). Severe SDI indirectly resulted in higher hospitalizations (β = 0.01; p = .01) and falls (β = 0.01; p = .001) through lower RN staffing but lower pressure ulcers (β = -0.07; p < .001) through higher CNA staffing. Directly, severe SDI increased pressure ulcers (β = 0.69; p < .001) and hospitalizations (β = 0.09; p < .001) and decreased falls (β = -0.53; p < .001).
Discussion and implications: Severe social deprivation affected nursing staff patterns, affecting care quality. These findings highlight the importance of considering environmental factors in the NH quality policymaking process.
期刊介绍：
Innovation in Aging, an interdisciplinary Open Access journal of the Gerontological Society of America (GSA), is dedicated to publishing innovative, conceptually robust, and methodologically rigorous research focused on aging and the life course. The journal aims to present studies with the potential to significantly enhance the health, functionality, and overall well-being of older adults by translating scientific insights into practical applications. Research published in the journal spans a variety of settings, including community, clinical, and laboratory contexts, with a clear emphasis on issues that are directly pertinent to aging and the dynamics of life over time. The content of the journal mirrors the diverse research interests of GSA members and encompasses a range of study types. These include the validation of new conceptual or theoretical models, assessments of factors impacting the health and well-being of older adults, evaluations of interventions and policies, the implementation of groundbreaking research methodologies, interdisciplinary research that adapts concepts and methods from other fields to aging studies, and the use of modeling and simulations to understand factors and processes influencing aging outcomes. The journal welcomes contributions from scholars across various disciplines, such as technology, engineering, architecture, economics, business, law, political science, public policy, education, public health, social and psychological sciences, biomedical and health sciences, and the humanities and arts, reflecting a holistic approach to advancing knowledge in gerontology.
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