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Health Serv Res. 2013 Feb;48(1):47-69. doi: 10.1111/j.1475-6773.2012.01431.x. Epub 2012 Jun 7.

The urban-rural disparity in nursing home quality indicators: the case of facility-acquired contractures.

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  • 1Department of Economics, Scripps Gerontology Center, Farmer School of Business, Miami University, 800 E. High Street, Oxford, OH 45056, USA. jbowblis@muohio.edu

Abstract

OBJECTIVE:

To identify and quantify the sources of the urban-rural disparity in facility-acquired contracture rates in nursing homes.

DATA SOURCES:

Survey inspection data of U.S. nursing homes from 1999 to 2008 and standardized national rural definition file from the Rural-Urban Commuting Area Codes.

STUDY DESIGN:

We estimated regressions of facility-level contracture rate as a function of urban-rural categories (urban, micropolitan, small rural town, and isolated small rural town) and other related facility characteristics to identify size of the urban-rural disparity. We used Blinder-Oaxaca decomposition techniques to determine the extent to which the disparity is attributable to the differences in facility and aggregate resident characteristics.

PRINCIPAL FINDINGS:

Rural nursing homes have higher contracture rates than urban nursing homes. About half of the urban-rural disparity is explained by differences in observable characteristics among urban and rural nursing homes. Differences in staffing levels explain less than 5 percent of the disparity, case-mix explains 6-8 percent, and structure and operational characteristics account for 10-22 percent of the disparity.

CONCLUSION:

While a lower level and quality of staffing are a concern for rural nursing homes, facility structure and funding sources explain a larger proportion of the urban-rural disparity in the quality of care.

© Health Research and Educational Trust.

PMID:
22670847
[PubMed - indexed for MEDLINE]
PMCID:
PMC3589954
Free PMC Article
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