This paper reviews the literature on racial/ethnic differences in nursing home quality, segregated access to nursing home care, and organizational and community factors that may influence access and quality of care. We present illustrative data on county demographics and the racial mix of African American residents in nursing homes in these counties for a sample of four states. We also briefly describe plans for multilevel modeling to test variation in racial/ethnic disparities in care as a function of nursing home structures and processes and community context.
Branco K, Teno J, Mor V. Advance care planning among nursing home residents: status prior to the implementation of the patient self-determination act. J Health Soc Pol. 1995;7:37-52.
2.
Zinn JS, Mor V. Nursing home special care units: distribution by type, state, and facility characteristics. Gerontologist. 1994; 34:371-377.
3.
Lapane KL, Jesdale B, Zierler S. Racial Disparities in Quality of Nursing Home Care. Final Report for AHCPR grant HS09552, 1999.
4.
Weissman JS, Stern R, Fielding SL, et al.Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med. 1991;114:325-331.
5.
Bernabei R, Gambassi G, Lapane K, et al.Characteristics of the SAGE database: a new resource for research on outcomes in long-term care. J Gerontol. 1998;53:M1-M9.
6.
Gambassi G, Landi F, Peng L, et al, on behalf of the SAGE Study Group. Validity of diagnostic and drug data in standardized nursing home resident assessment: potential for geriatric pharmacoepidemiology. Med Care. 1998;36:167-179.
7.
Hume AL, Barbour MM, Willey CJ, et al.Changing trends in antihypertensive therapy in two New England communities during the 1980s. Pharmacotherapy. 1993;13:244-251.
8.
Laveist TA. Segregation, poverty, and empowerment: health consequences for African Americans. Milbank Q. 1993;71:41-64.
9.
Smith DB. Population ecology and the racial integration of hospitals and nursing homes in the United States. Milbank Q. 1990; 68:561-596.
10.
Zinn JS, Mor V. Organizational structure and the delivery of primary care to older Americans. Health Serv Res. 1998;33:354-380.
11.
Flood AB, Scott RB. Hospital Structure and Performance. Baltimore, Md: The Johns Hopkins University Press;1987.
12.
Burns LR, Wholey DR. Medical organization structures that promote quality and efficiency: past research and future considerations. Qual Manag Health Care. 1995;3:10-18.
13.
Linn MW, Gurel L, Linn BS. Patient outcome as a measure of quality of nursing home care. Am J Public Health. 1977;67:337-344.
14.
Fries BE, Hawes C, Morris JN, et al.Effect of the National Resident Assessment Instrument on selected health conditions and problems. J Am Geriatr Soc. 1997;45:994-1001.
15.
Dansky KH, Brannon D, Wangsness S. Human resources management practices and patient satisfaction in home care. Home Health Care Serv Q. 1994;15:43-54.
16.
Blendon RJ, Aiken LH, Freeman HE, et al.Access to medical care for black and white Americans. A matter of continuing concern. JAMA. 1989;261:278-281.
17.
Bach PB, Cramer LD, Warren JL, et al.Racial differences in the treatment of early-stage lung cancer. N Engl J Med. 1999; 341: 1198-1205.
18.
Schulman KA, Berlin JA, Harless W, et al.The effect of race and sex on physicians' recommendations for cardiac catheterization. N Engl J Med. 1999;340:618-626.
19.
US Bureau of the Census. Current Population Reports, Special Studies. 65+ in the United States. Washington: US Government Printing Office;1996.
20.
Wallace SP, Levy-Storms L, Kington RS, et al.The persistence of race and ethnicity in the use of long-term care. J Gerontol B Psychol Sci Soc Sci. 1998;53:S104-S112.
21.
Miller SC, Prohaska TR, Furner SE. Nursing home admission for African Americans with Alzheimer's disease. J Gerontol Med Sci. 1999;54A(7):M363-M369.
22.
Institute of Medicine. Health Care in a Context of Civil Rights. Washington: National Academy Press;1981.
23.
Manton K, Patrick C, Johnson K. Health differentials between blacks and whites: recent trends in mortality and morbidity. In: Willis D, eds. Health Policies and Black Americans. New Brunswick, NJ: Transaction;1989:129-199.
24.
Johnson PA, Lee TH, Cook EF, et al.Effect of race on the presentation and management of patients with acute chest pain. Ann Intern Med. 1993;118:593-601.
25.
Renner EA, Engle VF, Graney MJ. Prevalence and predictors of regularly scheduled prescription medications of newly admitted nursing home residents. J Am Geriatr Soc. 1992;40:232-236.
26.
Glynn RJ, Gurwitz JH, Bohn RL, et al.Old age and race as determinants of initiation of glaucoma therapy. Am J Epidemiol. 1993;138:395-406.
27.
National Research Council. A Common Destiny: Blacks and American Society. Washington, DC: National Academy Press;1989;138, 156.
28.
Braun BI. The effect of nursing home quality on patient outcome. J Am Geriatr Soc. 1991;39:329-338.
29.
Kruzich JM, Clinton JF, Kelber ST. Personal and environmental influences on nursing home satisfaction. Gerontologist. 1992;32: 342-350.
30.
Aaronson WE, Zinn JS, Rosko MD. Do for-profit and not-for-profit nursing homes behave differently?Gerontologist. 1994;34: 775-786.
31.
Mor V, Intrator O, Fries BE, et al.Changes in hospitalization associated with introducing the Resident Assessment Instrument. J Am Geriatr Soc. 1997;45:1002-1010.
32.
Johnson-Pawlson J, Infeld DL. Nurse staffing and quality of care in nursing facilities. J Gerontol Nurs. 1996;22:36-45.
33.
Harrington C, Carillo H, Mullan J, et al.Nursing facility staffing in the states: the 1991 to 1995 period. Med Care Res Rev. 1998; 55:334-363.
34.
Donabedian A. Evaluating the quality of medical care. Milbank Meml Fund Q Health Soc. 1988;44:166.
35.
Sainfort F, Ramsay JD, Monato H. Conceptual and methodological sources of variation in the measurement of nursing facility quality: an evaluation of 24 models and an empirical study. Med Care Rev. 1995;52:60-68.
36.
Schoonhoven CB. Problems with contingency theory: testing assumptions hidden within the language of contingency theory. Admin Sci Q. 1981;26:349-377.
37.
Leatt P, Schneck R. Criteria for grouping nursing subunits in hospitals. Acad Manag J1984;27:150-165.
38.
Karuza J, Katz PR. Physician staffing patterns correlates of nursing home care: an initial inquiry and consideration of policy implications. J Am Geriatr Soc. 1994;42:787-793.
39.
Scott RW. Organizations: Rational, Natural, and Open Systems. 4th ed.Englewood Cliffs, NJ: Prentice Hall;1994.
40.
Chatman JA, Polzer JT, Barsade SG, et al.Being different yet feeling similar: the influence of demographic composition and organizational culture on work processes and outcomes. Admin Sci Q. 1998;43:749-780.
