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Untangling the Relationship Between Neighborhood Disadvantage, Quality, and COVID-19 Outcomes in Ohio Nursing Homes: A Spatial Analysis Approach

Qiu, Xiao
http://orcid.org/0000-0003-3896-4174
http://rave.ohiolink.edu/etdc/view?acc_num=miami1731587792345916

Abstract Details

2024, Doctor of Philosophy, Miami University, Gerontology.
The COVID-19 pandemic has exposed vulnerabilities within the healthcare system, with nursing homes in under-resourced communities particularly impacted. Numerous studies have linked community socioeconomic status to both care quality and COVID-19 outcomes in these settings, suggesting that nursing homes in disadvantaged neighborhoods provide lower quality care, resulting in poorer health outcomes for residents. However, whether high-quality nursing homes can effectively reduce these health disparities remains unclear. Additionally, conventional long-term care research often overlooks spatial relationships, which can introduce bias into findings. Understanding these dynamics is essential for building resilience against future health emergencies. This study explores the relationships among neighborhood disadvantage, care quality, and COVID-19 outcomes in Ohio nursing homes, examining the potential influence of spatial relationships. While nursing homes in more disadvantaged areas generally exhibit lower quality performance, these quality metrics do not show significant associations with neighborhood socioeconomic status after adjusting for organizational factors and resident characteristics. Instead, quality performance is associated with factors like financial health (e.g., Medicaid payor mix, occupancy rates), stable in-house staffing, consistent leadership, and resident demographics. The study also reveals consistently high mortality risks among residents in nursing homes located in disadvantaged neighborhoods, which are unaffected by quality performance indicators. While COVID-19 incidence rates among residents and staff show no significant associations with neighborhood socioeconomic status, higher CMS Five-Star Staffing ratings and resident satisfaction scores significantly reduce resident COVID-19 incidence rates over the two-year pandemic period. Conversely, higher CMS Five-Star Overall, Health Inspection, and Staffing ratings are linked to increased staff COVID-19 incidence rates, with community incidence rates and organizational factors also influencing outcomes. Significant spatial effects are identified across quality measures, including CMS Five-Star ratings and resident and family satisfaction scores, providing nuanced insights into rurality and other nursing home characteristics. Modest spatial effects are also observed in resident COVID-19 cases during the pre-vaccination period, highlighting the importance of spatial dynamics in public health responses. These findings underscore the complex interplay between neighborhood disadvantage, quality performance, and COVID-19 outcomes in nursing homes. Addressing these disparities requires targeted interventions that account for the intricate interdependencies within nursing home settings. Policymakers and researchers should consider spatial analyses when developing interventions, as overlooking spatial dynamics could lead to ineffective solutions.
J. Scott Brown (Committee Chair)
Robert Applebaum (Committee Member)
Jing Zhang (Committee Member)
Saruna Ghimire (Committee Member)
Suzanne Kunkel (Committee Member)
180 p.
Gerontology
long-term care; neighborhood disadvantage; Area Deprivation Index; nursing home quality; COVID-19; spatial analysis

Recommended Citations

Citations

  • Qiu, X. (2024). Untangling the Relationship Between Neighborhood Disadvantage, Quality, and COVID-19 Outcomes in Ohio Nursing Homes: A Spatial Analysis Approach [Doctoral dissertation, Miami University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=miami1731587792345916

    APA Style (7th edition)

  • Qiu, Xiao. Untangling the Relationship Between Neighborhood Disadvantage, Quality, and COVID-19 Outcomes in Ohio Nursing Homes: A Spatial Analysis Approach. 2024. Miami University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=miami1731587792345916.

    MLA Style (8th edition)

  • Qiu, Xiao. "Untangling the Relationship Between Neighborhood Disadvantage, Quality, and COVID-19 Outcomes in Ohio Nursing Homes: A Spatial Analysis Approach." Doctoral dissertation, Miami University, 2024. http://rave.ohiolink.edu/etdc/view?acc_num=miami1731587792345916

    Chicago Manual of Style (17th edition)

miami1731587792345916
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© 2024, some rights reserved.Creative Commons License Untangling the Relationship Between Neighborhood Disadvantage, Quality, and COVID-19 Outcomes in Ohio Nursing Homes: A Spatial Analysis Approach by Xiao Qiu is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. Based on a work at etd.ohiolink.edu.
This open access ETD is published by Miami University and OhioLINK.