July 13, 2011
Prevalence of Ulcers in Black Nursing Home Patients Due to Care?
(Ivanhoe Newswire) -- Among nursing home residents at high risk for pressure ulcers, black residents had higher prevalence rates than white residents from 2003 through 2008, with the disparity largely related to the higher rates among nursing homes that disproportionately serve black residents, according to this study,
"Pressure ulcers are a common health problem among nursing home residents and substantially increase morbidity, mortality, and the cost of care," the authors were quoted as saying. "A variety of nursing home quality improvement programs have been implemented during the last decade but their implications for racial disparities on quality are unknown."
Yue Li, Ph.D., of the University of Iowa, Iowa City, and colleagues analyzed the trend of pressure ulcer prevalence in nursing homes by race and site of care from 2003 through 2008. The study included data on pressure ulcer rates in 2.1 million white and 346,808 black residents of 12,473 certified nursing homes in the United States who were considered at high risk of developing pressure ulcers. Nursing homes were categorized according to their proportions of black residents.The researchers found that pressure ulcer rates decreased overall from 2003 through 2008 among high-risk residents of nursing homes, but black residents showed persistently higher pressure ulcer rates than white residents. The pressure ulcer rate among black residents decreased from 16.8 percent in 2003 to 14.6 percent in 2008 and the rate among white residents decreased from 11.4 percent in 2003 to 9.6 percent in 2008. Despite the lowered pressure ulcer rates over time for both races, racial disparity remained relatively unchanged.
Nursing home facilities with higher concentrations of black residents had higher rates of pressure ulcers for both black and white residents compared with nursing homes with lower concentrations of black residents. Nursing homes with higher concentrations of black residents tended to have lower staffing levels of registered nurses and certified nurse assistants and to be larger for-profit and urban facilities. "These facilities may be more financially disadvantaged when caring for patients predominantly receiving Medicaid," the authors said.
"Given the widespread racial disparities in nursing home care, it is imperative to close the gap beyond industry-wide improvements. The first key step would be understanding why these disparities exist before appropriate efforts can be made to eliminate them. Given that nursing home care for minority residents is concentrated among a small number of nursing homes, understanding how outcomes vary as a function of site of care can inform targeted interventions," the researchers were quoted as saying.
SOURCE: JAMA, published online July 13, 2011