David C. Grabowski is the principal investigator and contact person for this project. 

There has been a great deal of recent policy interest in racial and ethnic disparities in health care settings. These disparities in care can be decomposed into “across-facility” and “within-facility” variation in services. Across-facility variation refers to the difference in treatment of patients from one nursing facility to another, while within-facility variation denotes the difference in treatment of certain residents within a given nursing home.

Both types of disparities are important from a policy perspective, as poorer care processes are known to be associated with worse outcomes of care. However, across- and within-facility health care disparities may have very different implications for policymakers. A number of studies have documented across-facility disparities in nursing home care, but very little work has been conducted on within-facility disparities. Thus, the research component of this NIA Career Development Award examines within-facility variation in the quality of nursing home care by race and payer status. By using recent resident-level Minimum Data Set (MDS) data over multiple years, the study will greatly increase our understanding of differences in nursing home quality by payer status and race. The results will allow providers, advocates, clinicians, consumers, and policymakers to better evaluate and address within-facility disparities in nursing home care.