Poorer Quality Outcomes of Medicare-Certified Home Health Care in Areas With High Levels of Native American/Alaska Native Residents

Abstract

Objective: Compared with most other groups, many Native Americans or Alaska Natives (NA/AN) individuals are concentrated in rural areas, which typically have lower health service availability. We examined whether quality indicators reported to the Centers for Medicare and Medicaid Services (CMS) by Medicare-certified home health care agencies are equal in areas with high NA/AN concentration. Method: We conducted a cross-sectional analysis. The unit of analysis was the ZIP Code Tabulation Area (N = 32,239). The independent variable was NA/AN concentration at/above 4.2% (95th percentile). Dependent variables included risk-adjusted patient self-care quality measures. Results: Areas with high levels of NA/AN residents had poorer quality outcomes across both utilization (e.g., hospital admission) and improvement measures (e.g., walking, bathing), for 9 of 12 risk-adjusted patient self-care quality measures. Discussion: Identifying gaps in quality among multiple measures of home health care for high-risk areas allows practitioners and home health care service providers to target quality improvement interventions.