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Jung D, Song S, Ma C. Where Patients Live Matter in Emergency Department Visits in Home Health Care: Rural/Urban Status and Neighborhood Socioeconomic Status. J Appl Gerontol 2024; 43:933-944. [PMID: 37991851 DOI: 10.1177/07334648231216644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023] Open
Abstract
An increasing body of evidence highlights the importance of an individual's place of residence on their health and functional outcomes. This study is based on Outcome and Assessment Information Set data to assess the differences in emergency department visits among Medicare home health care patients by patients' residence location (rural/urban status and neighborhood socioeconomic status). Compared to urban patients, a disproportionately higher proportion of rural patients lived in more or most disadvantaged neighborhoods (83.9% vs. 41.3%). Using linear probability regression models, patients in rural areas (coefficient = .02, p < .001) and disadvantaged neighborhoods (less disadvantaged: coefficient = .02, p < .001; more disadvantaged: coefficient = .034, p < .001; most disadvantaged: coefficient = .042, p < .001) were more likely to experience emergency department visits. Policymakers should consider utilizing area-based target interventions to mitigate gaps in home health care. Also, given that the majority of rural patients reside in disadvantaged neighborhoods, neighborhood characteristics should be considered in addressing rural-urban disparities and improving home health care.
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Affiliation(s)
- Daniel Jung
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Suhang Song
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Gansa WH, Kleijwegt H, Aldridge M, Ankuda C. Individual Socioeconomic Factors Have a Greater Impact on End-of-Life Care Outcomes Than Regional Factors. J Palliat Med 2024; 27:160-167. [PMID: 37699248 PMCID: PMC11265611 DOI: 10.1089/jpm.2023.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 09/14/2023] Open
Abstract
Background: End-of-life (EoL) care provided to Americans in urban and rural settings is distinct in terms of both available and delivered services. However, much less is known about which geographic, demographic, and health indicators are associated with disparities in EoL care and how individual versus regional characteristics influence quality of care (QoC). Objective: This study aimed to assess how regionality, rurality, and individual socioeconomic factors are associated with QoC in the last month of life (LML). Design: Nationally representative cross-sectional study using the proxy-completed LML questionnaire as part of the National Health and Aging Trends Study (NHATS). The data were linked at the zip code level to geographic and economic indicators. Settings/Subjects: A total of 2778 NHATS enrollees who died from 2012 to 2020. Measurements: Measurements included population density, socioeconomic indicators, health factors, and health outcomes. The primary independent variable was proxy-reported QoC during the LML (excellent vs. not excellent). Results: In our sample, 52.1% (n = 1447) reported not excellent care and 47.9% (n = 1331) reported excellent care. These populations varied in their demographic and socioeconomic characteristics. After accounting for survey weighting and design, decedents in the top (odds ratio [OR]: 1.58; 95% confidence interval [CI]: 1.08-2.32) income quartile had significantly greater odds of receiving excellent care than decedents in the bottom quartile. Decedents in zip codes with top quartile health outcome metrics had significantly greater odds of receiving excellent care (OR: 1.64; 95% CI: 1.17-2.29) than decedents in zip codes with bottom quartile health outcomes. County rurality index and county health factors were not correlated with QoC in the LML. Conclusions: High QoC at the EoL may be more associated with individual socioeconomic factors than regional indicators, including degrees of rurality. Clinicians should strive to recognize the interplay of individual characteristics and regional indicators to provide more personalized care.
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Affiliation(s)
- William H. Gansa
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Hannah Kleijwegt
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa Aldridge
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Claire Ankuda
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Karmarkar AM, Roy I, Lane T, Shaibi S, Baldwin JA, Kumar A. Home health services for minorities in urban and rural areas with Alzheimer's and related dementia. Home Health Care Serv Q 2023; 42:265-281. [PMID: 37128943 DOI: 10.1080/01621424.2023.2206368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Timely access and continuum of care in older adults with Alzheimer's Disease and Related Dementia (ADRD) is critical. This is a retrospective study on Medicare fee-for-service beneficiaries with ADRD diagnosis discharged to home with home health care following an episode of acute hospitalization. Our sample included 262,525 patients. White patients in rural areas have significantly higher odds of delay (odds ratio [OR], 1.03; 95% CI, 1.01-1.06). Black patients in urban areas (OR, 1.15; 95% CI, 1.12-1.19) and Hispanic patients in urban areas also were more likely to have a delay (OR, 1.07; 95% CI, 1.03-1.11). Black and Hispanic patients residing in urban areas had a higher likelihood of delay in home healthcare initiation following hospitalization compared to Whites residing in urban areas.
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Affiliation(s)
- Amol M Karmarkar
- Department of Physical Medicine and Rehabilitation, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
- Research Department, Sheltering Arms Institute, Richmond, Virginia, USA
| | - Indrakshi Roy
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Taylor Lane
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Stefany Shaibi
- Physical Therapy Department, Creighton University, Phoenix, Arizona, USA
| | - Julie A Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Amit Kumar
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
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Karmarkar AM, Roy I, Rivera-Hernandez M, Shaibi S, Baldwin JA, Lane T, Kean J, Kumar A. Examining the role of race and quality of home health agencies in delayed initiation of home health services for individuals with Alzheimer's disease and related dementias (ADRD). Alzheimers Dement 2023; 19:4037-4045. [PMID: 37204409 PMCID: PMC10730234 DOI: 10.1002/alz.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION We examined differences in the timeliness of the initiation of home health care by race and the quality of home health agencies (HHA) among patients with Alzheimer's disease and related dementias (ADRD). METHODS Medicare claims and home health assessment data were used for the study cohort: individuals aged ≥65 years with ADRD, and discharged from the hospital. Home health latency was defined as patients receiving home health care after 2 days following hospital discharge. RESULTS Of 251,887 patients with ADRD, 57% received home health within 2 days following hospital discharge. Black patients were significantly more likely to experience home health latency (odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.11-1.19) compared to White patients. Home health latency was significantly higher for Black patients in low-rating HHA (OR = 1.29, 95% CI = 1.22-1.37) compared to White patients in high-rating HHA. DISCUSSION Black patients are more likely to experience a delay in home health care initiation than White patients.
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Affiliation(s)
- Amol M Karmarkar
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
- Research Department, Sheltering Arms Institute, Richmond, Virginia, USA
| | - Indrakshi Roy
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Maricruz Rivera-Hernandez
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Stefany Shaibi
- Physical Therapy Department, Creighton University, Phoenix, Arizona, USA
| | - Julie A Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Taylor Lane
- Center for Health Equity Research, Northern Arizona University, Flagstaff, Arizona, USA
| | - Jacob Kean
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Amit Kumar
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Physical Therapy and Athletic Training, College of Health, University of Utah, Salt Lake City, Utah, USA
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Longo BA, Schmaltz SP, Barrett SC, Patrianakos J, Williams SC. Home Health Agency Patient Experience Measures and Their Relationship to Joint Commission Accreditation. Jt Comm J Qual Patient Saf 2023; 49:313-319. [PMID: 37210303 DOI: 10.1016/j.jcjq.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Health care accreditation is a widely accepted mechanism for improving the quality of care and promoting patient safety. An integral dimension of health care quality is the patient experience of care. However, the influence of accreditation on the patient experience is unclear. The Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey is the standard for collecting patient care experience data in the home health setting. The aim of this study was to examine the association of Joint Commission accreditation on patients' experience of care by comparing HHCAHPS ratings from Joint Commission-accredited and non-Joint Commission-accredited home health agencies (HHAs). METHODS This multiyear observational study used 2015-2019 HHCAHPS data obtained from the Centers for Medicare & Medicaid Services (CMS) website and Joint Commission databases. The data set included 1,454 (23.8%) Joint Commission-accredited and 4,643 (76.2%) non-Joint Commission-accredited HHAs. Dependent variables included three composite measures of care (Care of Patients, Provider-Patient Communications, and Specific Care Issues) and two global rating measures. Data were analyzed using a series of longitudinal random effects logistic regression models. RESULTS This study found no association between Joint Commission accreditation and the two global HHCAHPS measures, modest significant increases for Joint Commission-accredited HHAs in measure rates for the Care of Patients and Communication composite measures (p < 0.05), and a more significant increase for the Specific Care Issues composite measure related to medication safety and home safety (p < 0.001). CONCLUSIONS These findings suggest that Joint Commission accreditation may be positively associated with some patient experience of care outcomes. This relationship was most pronounced when there was significant overlap between the focus of the accreditation standards and focus of the HHCAHPS items.
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Zawada SK, Sweat J, Paulson MR, Maniaci MJ. Staff Successes and Challenges with Telecommunications-Facilitated Patient Care in Hybrid Hospital-at-Home during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11091223. [PMID: 37174766 PMCID: PMC10178711 DOI: 10.3390/healthcare11091223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/15/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Technology-enhanced hospital-at-home (H@H), commonly referred to as hybrid H@H, became more widely adopted during the COVID-19 pandemic. We conducted focus group interviews with Mayo Clinic staff members (n = 14) delivering hybrid H@H in three separate locations-a rural community health system (Northwest Wisconsin), the nation's largest city by area (Jacksonville, FL), and a desert metropolitan area (Scottsdale, AZ)-to understand staff experiences with implementing a new care delivery model and using new technology to monitor patients at home during the pandemic. Using a grounded theory lens, transcripts were analyzed to identify themes. Staff reported that hybrid H@H is a complex care coordination and communication initiative, that hybrid H@H faces site-specific challenges modulated by population density and state policies, and that many patients are receiving uniquely high-quality care through hybrid H@H, partly enabled by advances in technology. Participant responses amplify the need for additional qualitative research with hybrid H@H staff to identify areas for improvement in the deployment of new models of care enabled by modern technology.
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Affiliation(s)
- Stephanie K Zawada
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic College of Medicine and Science, 13400 E. Shea Blvd., Scottsdale, AZ 85259, USA
| | - Jeffrey Sweat
- Social Science Department, University of Wisconsin-Stout, 712 Broadway St. S, Menomonie, WI 54751, USA
| | | | - Michael J Maniaci
- Mayo Clinic Florida, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
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Ma C, Dutton HJ, Wu B. Quality of care in home health agencies with and without accreditation: a cohort study. Home Health Care Serv Q 2023; 42:1-13. [PMID: 36117455 PMCID: PMC9901214 DOI: 10.1080/01621424.2022.2123756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
While home health agencies (HHAs) can seek accreditation to recognize their quality of service, it is unknown whether agencies with accreditation perform better in providing care than those without accreditation. Using 5-year data from national data sources, the aims of this study were: 1) to depict characteristics of HHAs with and without accreditation; and 2) to examine the relationship between accreditation status and HHA performance on quality-of-care metrics. This study analyzed 7,697 agencies in the US and found that 1) agencies that were for-profit, urban, not-hospital-affiliated, single-branch, Medicare enrolled only, and without hospice program were more likely to have accreditation; and 2) overall, accredited agencies performed better on the three commonly used quality indicators, timely initiation of care, hospitalization, and emergency department visit, though not all the observed differences were substantial in absolute value. Our results provide unique empirical information to agencies considering seeking accreditation.
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Affiliation(s)
- Chenjuan Ma
- NYU Rory Meyers College of Nursing, New York, New York, USA
| | | | - Bei Wu
- NYU Rory Meyers College of Nursing, New York, New York, USA
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Loomer L, Rahman M, Mroz TM, Gozalo PL, Mor V. Impact of higher payments for rural home health episodes on rehospitalizations. J Rural Health 2022. [PMID: 36336461 PMCID: PMC10163169 DOI: 10.1111/jrh.12725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE Home health agencies delivering care in rural counties face unique challenges when providing care to older adults; long travel times between each visit can limit the number of patients seen each day. In 2010, Medicare began paying home health (HH) providers 3% more to serve rural beneficiaries without evaluating the policy's impact on patient outcomes. METHODS Using 100% Medicare data on postacute HH episodes from 2007 to 2014, we estimated the impact of higher payments on beneficiaries outcomes using difference-in-differences analysis, comparing rehospitalizations between rural and urban postacute HH episodes before and after 2010. FINDINGS Our sample included 5.6 million postacute HH episodes (18% rural). In the preperiod, the 30- and 60-day rehospitalization rates for urban HH episodes were 11.30% and 18.23% compared to 11.38% and 18.39% for rural HH episodes. After 2010, 30- and 60-day rehospitalization rates declined, 10.08% and 16.49% for urban HH episodes and 9.87% and 16.08% for rural HH episodes, respectively. The difference-in-difference estimate was 0.29 percentage points (P = .005) and 0.57 percentage points (P < .001) for 30- and 60-day rehospitalization, respectively. CONCLUSIONS Increasing payments resulted in a statistically significant reduction in rehospitalizations for rural postacute HH episodes. The add-on payment is set to sunset in 2022 and its impact on access and quality to HH for rural older adults should be reconsidered.
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Affiliation(s)
- Lacey Loomer
- Department of Economics and Health Care Management Labovitz School of Business and Management University of Minnesota Duluth Minnesota USA
| | - Momotazur Rahman
- Center for Gerontology and Healthcare Research School of Public Health Brown University Providence Rhode Island USA
| | - Tracy M. Mroz
- Department of Rehabilitation Medicine University of Washington Washington Seattle USA
| | - Pedro L. Gozalo
- Center for Gerontology and Healthcare Research School of Public Health Brown University Providence Rhode Island USA
- Providence VA Medical Center Providence Rhode Island USA
| | - Vincent Mor
- Department of Economics and Health Care Management Labovitz School of Business and Management University of Minnesota Duluth Minnesota USA
- Center for Gerontology and Healthcare Research School of Public Health Brown University Providence Rhode Island USA
- Providence VA Medical Center Providence Rhode Island USA
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