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AJPH First Look, published online ahead of print May 30, 2006
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AJPH.2005.062224v1
96/7/1249    most recent
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July 2006, Vol 96, No. 7 | American Journal of Public Health 1249-1253
© 2006 American Public Health Association
DOI: 10.2105/AJPH.2005.062224

RESEARCH AND PRACTICE

Effect of Educational Level and Minority Status on Nursing Home Choice After Hospital Discharge

Joseph Angelelli, PhD, David C. Grabowski, PhD and Vincent Mor, PhD

Joseph Angelelli is with Pennsylvania State University, University Park. David Grabowski is with Harvard University, Cambridge, Mass. Vincent Mor is with Brown University, Providence, RI.

Correspondence: Requests for reprints should be sent to Joseph Angelelli, 116 Henderson Building, The Pennsylvania State University, University Park, PA 1680–2500 (e-mail: jangel{at}psu.edu).

Objectives. The movement to publicly report data on provider quality to inform consumer choices is predicated on assumptions of equal access and knowledge. We examine the validity of this assumption by testing whether minority/less educated Medicare patients are at greater risk of being discharged from a hospital to the lowest-quality nursing homes in a geographic area.

Methods. We used the 2002 national Minimum Data Set to identify 62601 new Medicare admissions to nursing homes in 95 hospital service areas with at least 4 freestanding nursing homes and at least 50 African Americans aged 65 years or older with Medicare admissions to nursing homes.

Results. The probability of African Americans’ being admitted to nursing homes in the lowest-quality quartile in the area was greater (relative risk [RR]=1.26; 95% confidence interval [CI]=1.0, 8.45) in comparison with Whites. Individuals without a high-school degree were also more likely to be admitted to a low-quality nursing home (RR=1.22; 95% CI=1.0, 1.46).

Conclusions. African American and poorly educated patients enter the worst-quality nursing facilities. This finding raises concerns about the usefulness of the current public reporting model for certain consumers.




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