Examine the relationships between dual eligibility and race/ethnicity characteristics of Medicare-Certified Home Health Agencies (CHHAs) and experience of care ratings.
Methods
Analysis of 2017 national Consumer Assessment of Healthcare Providers and Systems and matched datasets of 10,906 CHHAs
Results
CHHAs with higher concentrations of dual-eligible patients were less likely to have high experience of care ratings for all three domains (e.g., for care delivery, quartile 4 vs. 1: odds ratio [OR] = 0.622, p < .001); CHHAs with higher concentrations of racial/ethnic minorities generally were less likely to have high experience of care ratings in care delivery (e.g., Black: quartile 4 vs. 1: OR = 0.418, p<0.001), communication (e.g., Black: quartile 4 vs. 1: OR = 0.316, p<0.001), and specific care issues (e.g., Hispanic: quartile 4 vs. 1: OR = 0.397, p < .001).
Discussion
CHHAs with greater concentrations of dual-eligible patients and racial/ethnic minorities were more likely to have poor experience of care ratings.
AdelaniM. A.NunleyR. M.ClohisyJ. C.BarrackR. L. (2018). Patient perceptions of home health care services after total joint replacement. Orthopedics, 41(5), e713–e717. https://doi.org/10.3928/01477447-20180828-01
Alliance for Home Health Quality and Innovation. (2021). Research briefing #1—home health value based purchasing. Home health agencies in the changing policy environment. Retrieved August 23, 2021, fromhttps://www.ahhqi.org/research/home-health-research-grant
4.
AnkudaC. K.LeffB.RitchieC. S.RahmanO.-K.FerreiraK. B.Bollens-LundE.OrnsteinK. A. (2020). Implications of 2020 skilled home healthcare payment reform for persons with Dementia. Journal of the American Geriatrics Society, 68(10), 2303–2309. https://doi.org/10.1111/jgs.16654
5.
BlackB. S.JohnstonD.LeoutsakosJ.ReulandM.KellyJ.AmjadH.DavisK.WillinkA.SloanD.LyketsosC.SamusQ. M. (2019). Unmet needs in community-living persons with dementia are common, often non-medical and related to patient and caregiver characteristics. International Psychogeriatrics, 31(11), 1643–1654. https://doi.org/10.1017/S1041610218002296
6.
BrodyA. A.GuanC.CortesT.GalvinJ. E. (2016). Development and testing of the Dementia Symptom Management at Home (DSM-H) program: An interprofessional home health care intervention to improve the quality of life for persons with dementia and their caregivers. Geriatric Nursing (New York, NY), 37(3), 200–206. https://doi.org/10.1016/j.gerinurse.2016.01.002
7.
CabinW.SimanM. L. (2014). Are consumers satisfied with medicare home health: An initial exploration of patient satisfaction determinants. Home Health Care Management & Practice, 26(4), 198–204. https://doi.org/10.1177/1084822314527764
8.
ChaseJ. D.RussellD.HuangL.HanlonA.O’ConnorM.BowlesK. H. (2018). Relationships between race/ethnicity and health care utilization among older post-acute home health care patients. Journal of Applied Gerontology, 39(2), 201–213. https://doi.org/10.1177/0733464818758453
9.
ChenH. F.TilfordJ. M.WanF.SchuldtR. (2018). CMS HCC risk scores and home health patient experience measures. The American Journal of Managed Care, 24(10), e319–e324. https://doi.org/10.37765/ajmc.2020.88505
10.
ChimentiC.SearsG.McIntyreJ. (2020). Sepsis in home health care: Screening, education, and rapid triage. Journal of Nursing Care Quality, 36(3), 210–216. https://doi.org/10.1097/ncq.0000000000000525
CollinsT. L.YongK. W.MarchettiM. T.MillerK. L.BoothsB.FalveyJ. R. (2019). The value of home health physical therapy. Home Healthc Now, 37(3), 145–151. https://doi.org/10.1097/nhh.0000000000000760
18.
FongwaM. N.CunninghamW.Weech-MaldonadoR.GutierrezP. R.HaysR. D. (2008). Reports and ratings of care: Black and white Medicare enrollees. Journal of Health Care for the Poor and Underserved, 19(4), 1136–1147. https://doi.org/10.1353/hpu.0.0074
19.
FortinskyR. H.MadiganE. A.SheehanT. J.Tullai-McGuinnessS.KleppingerA. (2014). Risk factors for hospitalization in a national sample of medicare home health care patients. Journal of Applied Gerontology : The Official Journal of the Southern Gerontological Society, 33(4), 474–493. https://doi.org/10.1177/0733464812454007
20.
FreburgerJ. K.HolmesG. M.KuL. J. (2012). Postacute rehabilitation care for hip fracture: Who gets the most care?Journal of the American Geriatrics Society, 60(10), 1929–1935. https://doi.org/10.1111/j.1532-5415.2012.04149.x
21.
GrantL. A.RockwoodT.StennesL. (2015). Client satisfaction with telehealth services in home health care agencies. Journal of Telemedicine and Telecare, 21(2), 88–92. https://doi.org/10.1177/1357633x14566589
Harris-KojetinL.SenguptaM.Park-LeeE.ValverdeP.CafferyC.RomeV.LendonJ. (2016). Long-term care providers and service users in the United States: Data from the national study of long-term care providers, 2013-2014. Hyattsville, MA. Retrieved fromhttp://www.cdc.gov/nchs/data/series/sr_03/sr03_038.pdf
24.
HarrisonK. L.LeffB.AltanA.DunningS.PattersonC. R.RitchieC. S. (2020). What’s happening at home: A claims-based approach to better understand home clinical care received by older adults. Medical Care, 58(4), 360–367. https://doi.org/10.1097/mlr.0000000000001267
25.
IkedaT.SugiyamaK.AidaJ.TsuboyaT.WatabikiN.KondoK.OsakaK. (2019). Socioeconomic inequalities in low back pain among older people: The JAGES cross-sectional study. International Journal for Equity in Health, 18(1), 15. https://doi.org/10.1186/s12939-019-0918-1
Joynt MaddoxK. E.ChenL. M.ZuckermanR.EpsteinA. M. (2018). Association between race, neighborhood, and medicaid enrollment and outcomes in medicare home health care. Journal of the American Geriatrics Society, 66(2), 239–246. https://doi.org/10.1111/jgs.15082
28.
JoyntM.TrainM. K.RobbinsB. W.HaltermanJ. S.CaiolaE.FortunaR. J. (2013). The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States. Journal of General Internal Medicine, 28(12), 1604–1610. https://doi.org/10.1007/s11606-013-2516-z
29.
LinesL. M.AndersonW. L.BlackmonB. D.PronierC. R.AllenR. W.KenyonA. E. (2018). Qualitative analysis and conceptual mapping of patient experiences in home health care. Home Health Care Services Quarterly, 37(1), 25–40. https://doi.org/10.1080/01621424.2017.1421490
30.
MadiganE. A.GordonN.FortinskyR. H.KoroukianS. M.PiñaI.RiggsJ. S. (2012). Predictors of functional capacity changes in a US population of medicare home health care patients with heart failure. Archives of Gerontology and Geriatrics, 54(3), e300–e306. https://doi.org/10.1016/j.archger.2011.07.018
OsakweZ. T.LarsonE.AndrewsH.ShangJ. (2019). Activities of daily living of home healthcare patients. Home Healthc Now, 37(3), 165–173. https://doi.org/10.1097/nhh.0000000000000736
34.
PengT. R.Navaie-WaliserM.FeldmanP. H. (2003). Social support, home health service use, and outcomes among four racial-ethnic groups. Gerontologist, 43(4), 503–513. https://doi.org/10.1093/geront/43.4.503
35.
RosatiR. J.HuangL.Navaie-WaliserM.FeldmanP. H. (2003). Risk factors for repeated hospitalizations among home healthcare recipients. Journal for Healthcare Quality, 25(2), 4–11. https://doi.org/10.1111/j.1945-1474.2003.tb01038.x
36.
SahaS.HickamD. H. (2003). Explaining low ratings of patient satisfaction among Asian-Americans. American Journal of Medical Quality, 18(6), 256–264. https://doi.org/10.1177/106286060301800606
37.
SantomassinoM.CostantiniG. D.McDermottM.PrimianoD.SlyerJ. T.SingletonJ. K. (2012). A systematic review on the effectiveness of continuity of care and its role in patient satisfaction and decreased hospital readmissions in the adult patient receiving home care services. JBI Libr Syst Rev, 10(21), 1214–1259. https://doi.org/10.11124/01938924-201210210-00001
38.
SarzynskiE.EnsbergM.ParkinsonA.FitzpatrickL.HoudeshellL.GivenC.BrooksK. (2019). Eliciting nurses’ perspectives to improve health information exchange between hospital and home health care. Geriatric Nursing (New York, NY), 40(3), 277–283. https://doi.org/10.1016/j.gerinurse.2018.11.001
39.
SchwartzM. L.MrozT. M.ThomasK. S. (2020). Are patient experience and outcomes for home health agencies related?Medical Care Research and Review, 1077558720968365, 1–10. https://doi.org/10.1177/1077558720968365
40.
SmithL. M.AndersonW. L.KenyonA.KinyaraE.WithS. K.TeichmanL.GoldsteinE. (2015). Racial and ethnic disparities in patients’ experience with skilled home health care services. Medical Care Research and Review, 72(6), 756–774. https://doi.org/10.1177/1077558715597398
41.
SmithL. M.AndersonW. L.LinesL. M.PronierC.ThornburgV.ButlerJ. P.GoldsteinE. (2017). Patient experience and process measures of quality of care at home health agencies: Factors associated with high performance. Home Health Care Services Quarterly, 36(1), 29–45. https://doi.org/10.1080/01621424.2017.1320698
42.
TeshaleS. M.SchwartzM. L.ThomasK. S.MrozT. M. (2020). Early effects of home health value-based purchasing on quality star ratings. Medical Care Research and Review, 1077558720952298. 1–10. https://doi.org/10.1177/1077558720952298
43.
TowneS. D.Jr.ProbstJ. C.MitchellJ.ChenZ. (2015). Poorer quality outcomes of medicare-certified home health care in areas with high levels of native american/alaska native residents. Journal of Aging and Health, 27(8), 1339–1357. https://doi.org/10.1177/0898264315583051
44.
WangJ.CaprioT.V.SimningA.ShangJ.ConwellY.YuFLiY. (2020a). Association between home health services and facility admission in older adults with and without alzheimer’s disease and related dementias. Journal of the American Medical Directors Association, 21(5); 627–633.e9. https://doi.org/10.1016/j.jamda.2019.11.002
45.
WangJ.MonroeT. B.SimningA.ConwellY.CaprioT. V.CaiX.Temkin-GreenerH.MuenchU.YuF.GeS.LiY. (2021a). Pain management in home health care: relationship with dementia and facility admissions. Pain Management Nursing, 22(1), 36–43. https://doi.org/10.1016/j.pmn.2020.06.007
46.
WangJ.SimmonsS.MaxwellC. A.SchlundtD. G.MionL. (2018). Home health nurses’ perspectives and care processes related to older persons’ frailty and depression: A mixed method pilot study. Journal of Community Health Nursing, 35(3), 118–136. https://doi.org/10.1080/07370016.2018.1475799
47.
WangY.SpatzE. S.TariqM.AngraalS.KrumholzH. M. (2017). Home Health Agency Performance in the United States: 2011–2015. Journal of the American Geriatrics Society, 65(12), 2572–2579. https://doi.org/10.1111/jgs.14987
48.
WangJ.YingM.Temkin-GreenerH.ShangJ.CaprioT. V.LiY. (2020b). Utilization and Functional Outcomes Among Medicare Home Health Recipients Varied Across Living Situations. Journal of the American Geriatrics Society, 69(3), 704–710. https://doi.org/10.1111/jgs.16949
49.
WangJ.YingM.Temkin-GreenerH.ShangJ.CaprioT. V.LiY. (2021b). Utilization and functional outcomes among medicare home health recipients varied across living situations. Journal of the American Geriatrics Society, 69(3), 704–710. https://doi.org/10.1111/jgs.16949.
50.
WangJ.YuF.CaiX.CaprioT. V.LiY. (2020c). Functional outcome in home health: Do racial and ethnic minority patients with dementia fare worse?PLos One, 15(5), e0233650. https://doi.org/10.1371/journal.pone.0233650
51.
Weech-MaldonadoR.ElliottM. N.MoralesL. S.SpritzerK.MarshallG. N.HaysR. D. (2004). Health plan effects on patient assessments of Medicaid managed care among racial/ethnic minorities. Journal of General Internal Medicine, 19(2), 136–145. https://doi.org/10.1111/j.1525-1497.2004.30235.x
52.
Weech-MaldonadoR.ElliottM. N.OluwoleA.SchillerK. C.HaysR. D. (2008). Survey response style and differential use of CAHPS rating scales by Hispanics. Medical Care, 46(9), 963–968. https://doi.org/10.1097/MLR.0b013e3181791924
53.
Yeboah-KorangA.KleppingerA.FortinskyR. H. (2011). Racial and ethnic group variations in service use in a national sample of Medicare home health care patients with type 2 diabetes mellitus. Journal of the American Geriatrics Society, 59(6), 1123–1129. https://doi.org/10.1111/j.1532-5415.2011.03424.x
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