This application proposes a competing continuation of """"""""Adequacy of Home Care for Chronically Ill Elderly"""""""" (RO1 HS 06406-01). The findings of that study reveal that African-Americans are discharged home from the hospital sicker than their white counterparts, with different levels of formal and informal care, and with care plans that are rated less adequate. Using data from this project and two related studies, the continuation project, """"""""Post-Hospital Care of African-American Elderly,"""""""" aims to provide explanations for these differences. Specifically, investigators will (1) test the operation of three widely suggested determinants of care: (a) culturally related preferences, (b) service system barriers (in discharge planners' assessment and intervention and in orders for Medicare home health care), and (c) insufficient resources to procure needed services; and (2) examine the stressors and coping mechanisms of African-Americans once they are discharged home from the hospital. Data derive from three available data sets, with sample sizes of 250, 395, and 147 older adults. African-Americans comprise 49%, 33%, and 60%, respectively. Data were collected from medical records, home health agency records, discharge planner records, patient interviews, and nurse-conducted inhome assessments. Race is the major independent variable of interest; socioeconomic status and medical need are key control variables. Bivariate and mulltivariate procedures will be used to test the hypotheses that African-Americans express preferences for lower levels of care, receive less thorough discharge planning, are ordered fewer Medicare home-care services, experience socioeconomic constraints which influence their care, have more hazardous home environments, experience more stressors in home care, yet have higher levels of social support and religiosity. The project is significant in its multidimensional perspective on determinants of service utilization; its capacity to address such process factors as patient and family decision making and professional assessment and planning; and its examination of different phases of service utilization, including planning, implementation and the experiences of patients in home care after discharge. Further, the study will make a unique contribution to knowledge about minority health care by empirically testing alternative explanations for documented race differences.
| Chadiha, L A; Proctor, E K; Morrow-Howell, N et al. (1995) Post-hospital home care for African-American and white elderly. Gerontologist 35:233-9 |
