Reports have highlighted the significant cuts in Medicare home health benefits recently. Racial/ethnic minorities have been especially affected. Studies have provided some initial, but inconclusive, evidence that these decreases in service are having a larger impact on home health outcomes for minorities. Limitations in prior research, prevent us from determining whether and to what extent race is a critical factor in home health outcomes. Understanding racial/ethnic disparities in the home health system is essential for advancing the overall health of the Medicare population. By improving the health care and status of minority patients we stand to greatly improve the effectiveness of our healthcare system and reduce costs from morbidity and mortality. The goal of the study is to enhance understanding of the patient, agency, clinical practice, and system factors that contribute to racial disparities in home health as a first step toward alleviating disparities.
The specific aims are to: examine the relationship between race/ethnicity and home health outcomes including health status and adverse events;explore the patient, agency, and system factors that mediate/moderate the relationship between race/ethnicity and home health outcomes;conduct qualitative interviews with home care agency staff to help interpret the quantitative findings, and explore the clinical practice factors that influence the relationship between race/ethnicity and outcomes. This mixed methods study will combine data from the Outcome Assessment Information Set (OASIS), Home Health Agency Standard Analytical File (HHASAF), Provider of Services (POS) file, census, and Area Resource File (ARF). By combining multiple data sets representing the entire population of Medicare home health users the study will analyze a comprehensive set of patient, clinical practice, agency, and system factors that may contribute to disparities;examine outcomes for more racial/ethnic groups than previous studies;enhance representativeness;better approximate the complex construct of health outcomes by examining its multiple dimensions;and have adequate power to examine multiple contributing factors with controls. Regression will be used to identify mediators and moderators. Change in health status between admission to home care and discharge will be measured via OASIS data items covering functional, physiologic, cognitive and behavioral dimensions of health. Adverse events such as emergency care, hospitalization, or discharge with care needs occurring during the home care episode will also be analyzed. The quantitative analysis will also be used to identify high and low performing agencies by race on outcomes for the qualitative interviews. Qualitative interviews with home health agency staff around the nation will be used to interpret the findings of the quantitative work and to more deeply explore clinical practice factors which contribute to disparities in home care. This sequential mixed methods study will enable critical evaluation of the impact of race on home health outcomes and agency staff views on what patient, clinical practice, agency, and system interventions would be most appropriate to implement change. Public Health Relevance: Health disparities are a critical public health concern for 2 reasons: 1) they are indicative of an underlying inequality in our health care system;and 2) they result in poorer outcomes for minority and other vulnerable populations. Our focus on how disparities occur in Medicare home health care, emphasizes factors amenable to change thereby enabling us to develop specific interventions to reduce such disparities. The elimination of racial/ethnic health disparities holds the greatest promise to improve the overall health status of our society, while at the same time directly benefiting vulnerable populations.
Health disparities are a critical public health concern for 2 reasons: 1) they are indicative of an underlying inequality in our health care system;and 2) they result in poorer outcomes for minority and other vulnerable populations. Our focus on how disparities occur in Medicare home health care, emphasizes factors amenable to change thereby enabling us to develop specific interventions to reduce such disparities. The elimination of racial/ethnic health disparities holds the greatest promise to improve the overall health status of our society, while at the same time directly benefiting vulnerable populations.
