INTRODUCTIONPeople living with dementia are less likely to be admitted to high‐rated nursing homes than people without dementia, despite their increased care needs. We investigated the effect of admission to nursing homes with higher staffing ratings on adverse outcomes for individuals with and without dementia post‐hospitalization.METHODSAmong Traditional Medicare beneficiaries discharged to nursing homes between 2011 and 2017, we examined the relationship between facility staffing star‐ratings and short‐term readmission and mortality using an instrumental variables approach to account for selection bias. The instrumental variables were the number of nearby vacant beds in high‐rated facilities.RESULTSAdmission to a higher‐rated nursing home lowered post‐discharge mortality risk at 90 days and reduced 30‐ and 90‐day readmission. Point estimates were larger for people with dementia.DISCUSSIONFindings underscore the need for enhancing direct care staffing in nursing homes and addressing access disparities, particularly for individuals with dementia who benefit significantly from high‐quality care.Highlights We assessed how admission to nursing homes with higher staffing ratings impacted outcomes for individuals with and without dementia by exploiting variation in local bed vacancies as a source of quasi‐random assignment. For both persons with and without dementia, adjusted short‐term mortality and readmission rates were lower among those discharged to nursing homes with higher staffing ratings. Effects were larger for persons with dementia, indicating welfare loss from inequitable access to higher‐rated nursing homes. Increasing staffing in nursing homes and reducing disparities for persons with dementia is essential for enhancing both equity and value.

中文翻译：

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专业护理机构质量对患有痴呆症的医疗保险受益人的影响：来自职位空缺的证据


引言尽管护理需求增加，但与没有痴呆症的人相比，患有痴呆症的人不太可能被送入高评级的疗养院。我们调查了入住人员配备评级较高的疗养院对住院后有和无 痴呆个体不良结局的影响。方法对于 2011 年至 2017 年间出院到疗养院的传统 Medicare 受益人，我们使用工具变量方法来解释选择偏倚，研究了设施人员配备星级评定与短期再入院和死亡率之间的关系。工具变量是高评级设施中附近空床位的数量。结果转移到更高等级的疗养院降低了 90 天的出院后死亡风险，并减少了 30 天和 90 天的再入院率。痴呆患者的点估计值更大。讨论 Findings 强调了加强疗养院直接护理人员配备和解决可及性差异的必要性，特别是对于从高质量护理中受益匪浅的痴呆症患者。亮点 我们通过利用当地床位空缺的变化作为准随机分配的来源，评估了入住人员配备评级较高的疗养院如何影响有痴呆和无个体的结果。对于患有和没有痴呆症的人，在出院到人员配备评级较高的疗养院的人中，调整后的短期死亡率和再入院率较低。对痴呆症患者的影响更大，表明不公平地进入更高评级的疗养院会导致福利损失。增加疗养院的人员配备和减少痴呆患者的差距对于提高公平和价值至关重要。