Abstract：
OBJECTIVE: To investigate disparities in admissions to highly rated skilled nursing facilities (SNFs) between Medicare beneficiaries with and without opioid use disorder (OUD).
METHODS: Nationwide, retrospective observational cohort.
METHODS: Medicare Fee-for-Service beneficiaries aged ≥18 years admitted to SNFs following hospitalization during 2016-2020 (n = 30,922 with OUD and n = 137,454 without OUD).
METHODS: Data used were 100% Medicare inpatient claims, nursing home administrative databases, and Nursing Home Compare. We identified hospitalized patients with and without OUD and matched them on age, sex, Part D low-income subsidy (LIS), and residential county. We compared the overall and component (quality, staffing, and health inspections) star ratings of SNFs that beneficiaries entered. Beneficiary-level regression models were conducted adjusting for race and ethnicity, Medicare-Medicaid dual status, comorbidity score, hospital length of stay, and state and year fixed effects.
RESULTS: The overall study sample had a mean (SD) age of 71.4 (11.4) years, 63.9% were female, and 57.4% had LIS. Among beneficiaries with OUD, 50.3% entered SNFs with above-average (4 or 5) overall rating compared with 51.3% among those without OUD. Distributions of above-average ratings among beneficiaries with and without OUD were as follows: 63.9% vs 62.2% for quality, 32.8% vs 34.9% for health inspections, and 46.2% vs 45.0% for staffing, respectively. Adjusted regression models indicated that beneficiaries with OUD were less likely to be admitted to facilities with above-average overall (OR 0.90, 95% CI 0.87-0.92), health inspection (OR 0.90, 95% CI 0.88-0.93), and staffing (OR 0.91, 95% CI 0.89-0.94) ratings compared with beneficiaries without OUD, whereas quality (OR 0.98, 95% CI 0.95-1.01) ratings did not differ.
CONCLUSIONS: Despite mixed results on component ratings, our findings suggest a concerning disparity in the overall quality of SNFs admitting Medicare beneficiaries with OUD. Enhancing equitable access to high-quality SNF care for individuals with OUD is imperative amid rising demand and legal protections under the American Disabilities Act.
METHODS: Nationwide, retrospective observational cohort.
METHODS: Medicare Fee-for-Service beneficiaries aged ≥18 years admitted to SNFs following hospitalization during 2016-2020 (n = 30,922 with OUD and n = 137,454 without OUD).
METHODS: Data used were 100% Medicare inpatient claims, nursing home administrative databases, and Nursing Home Compare. We identified hospitalized patients with and without OUD and matched them on age, sex, Part D low-income subsidy (LIS), and residential county. We compared the overall and component (quality, staffing, and health inspections) star ratings of SNFs that beneficiaries entered. Beneficiary-level regression models were conducted adjusting for race and ethnicity, Medicare-Medicaid dual status, comorbidity score, hospital length of stay, and state and year fixed effects.
RESULTS: The overall study sample had a mean (SD) age of 71.4 (11.4) years, 63.9% were female, and 57.4% had LIS. Among beneficiaries with OUD, 50.3% entered SNFs with above-average (4 or 5) overall rating compared with 51.3% among those without OUD. Distributions of above-average ratings among beneficiaries with and without OUD were as follows: 63.9% vs 62.2% for quality, 32.8% vs 34.9% for health inspections, and 46.2% vs 45.0% for staffing, respectively. Adjusted regression models indicated that beneficiaries with OUD were less likely to be admitted to facilities with above-average overall (OR 0.90, 95% CI 0.87-0.92), health inspection (OR 0.90, 95% CI 0.88-0.93), and staffing (OR 0.91, 95% CI 0.89-0.94) ratings compared with beneficiaries without OUD, whereas quality (OR 0.98, 95% CI 0.95-1.01) ratings did not differ.
CONCLUSIONS: Despite mixed results on component ratings, our findings suggest a concerning disparity in the overall quality of SNFs admitting Medicare beneficiaries with OUD. Enhancing equitable access to high-quality SNF care for individuals with OUD is imperative amid rising demand and legal protections under the American Disabilities Act.
摘要：
目的：调查有和没有阿片类药物使用障碍（OUD）的Medicare受益人在接受高评级的专业护理机构（SNF）方面的差异。
方法：全国范围，回顾性观察队列。
方法：2016-2020年期间住院后，年龄≥18岁的Medicare按服务收费受益人接受SNF（n=30,922，OUD，n=137,454）。
方法：使用的数据是100%医疗保险住院索赔，疗养院管理数据库，和疗养院比较。我们确定了有和没有OUD的住院患者，并根据他们的年龄进行了匹配，性别,D部分低收入补贴(LIS)，和居民县。我们比较了整体和组件(质量，人员配备，和健康检查）受益人输入的SNF的星级评定。受益人水平回归模型进行了种族和民族调整，医疗保险-医疗补助双重地位，合并症评分，住院时间,以及州和年度固定效应。
结果：总体研究样本的平均（SD）年龄为71.4（11.4）岁，63.9%是女性，57.4%有LIS。在OUD的受益人中，50.3％的人进入了具有高于平均水平（4或5）的总体评级的SNF，而没有OUD的人则为51.3％。在有和没有OUD的受益人中，高于平均水平的评分分布如下：质量为63.9%，质量为62.2%，32.8%，健康检查为34.9%，和46.2%，而人员配备为45.0%，分别。调整后的回归模型表明，OUD受益人不太可能被允许进入总体高于平均水平的设施(OR0.90，95%CI0.87-0.92)，健康检查(OR0.90，95%CI0.88-0.92)，与没有OUD的受益人相比，以及人员配备(OR0.91，95%CI0.89-0.94)评级，而质量(OR0.98,95%CI0.94-1.01)评级没有差异。
结论：尽管成分评级结果参差不齐，我们的研究结果表明,接纳MedicareOUD受益人的SNF总体质量存在令人担忧的差异.根据《美国残疾人法》，在需求和法律保护不断增加的情况下，必须为OUD患者提供高质量的SNF护理。
方法：全国范围，回顾性观察队列。
方法：2016-2020年期间住院后，年龄≥18岁的Medicare按服务收费受益人接受SNF（n=30,922，OUD，n=137,454）。
方法：使用的数据是100%医疗保险住院索赔，疗养院管理数据库，和疗养院比较。我们确定了有和没有OUD的住院患者，并根据他们的年龄进行了匹配，性别,D部分低收入补贴(LIS)，和居民县。我们比较了整体和组件(质量，人员配备，和健康检查）受益人输入的SNF的星级评定。受益人水平回归模型进行了种族和民族调整，医疗保险-医疗补助双重地位，合并症评分，住院时间,以及州和年度固定效应。
结果：总体研究样本的平均（SD）年龄为71.4（11.4）岁，63.9%是女性，57.4%有LIS。在OUD的受益人中，50.3％的人进入了具有高于平均水平（4或5）的总体评级的SNF，而没有OUD的人则为51.3％。在有和没有OUD的受益人中，高于平均水平的评分分布如下：质量为63.9%，质量为62.2%，32.8%，健康检查为34.9%，和46.2%，而人员配备为45.0%，分别。调整后的回归模型表明，OUD受益人不太可能被允许进入总体高于平均水平的设施(OR0.90，95%CI0.87-0.92)，健康检查(OR0.90，95%CI0.88-0.92)，与没有OUD的受益人相比，以及人员配备(OR0.91，95%CI0.89-0.94)评级，而质量(OR0.98,95%CI0.94-1.01)评级没有差异。
结论：尽管成分评级结果参差不齐，我们的研究结果表明,接纳MedicareOUD受益人的SNF总体质量存在令人担忧的差异.根据《美国残疾人法》，在需求和法律保护不断增加的情况下，必须为OUD患者提供高质量的SNF护理。
