Rural and urban disparities in quality of home health care: A longitudinal cohort study (2014-2018)
Rural and urban disparities in quality of home health care: A longitudinal cohort study (2014-2018)
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DOI：
10.1111/jrh.12642
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发表时间：
2022-01-05
影响因子：
4.9
通讯作者：
O'Connor, Melissa
中科院分区：
文献类型：
--
作者：
Ma, Chenjuan;Devoti, Andrea;O'Connor, Melissa
家庭医疗保健是美国增长最快的医疗保健部门之一。然而，很少有人知道农村和城市家庭保健机构之间的质量性能的趋势随着时间的推移的差异。该研究旨在研究2014年至2018年期间农村和城市家庭卫生机构之间的质量绩效差异。方法采用2014-2018年全国家庭健康比较数据和服务提供者概况数据进行队列研究，包括7，908个家庭健康机构，其中1，537个是农村机构。质量性能指标包括及时启动护理、住院和急诊科（艾德）访视。两个层次的分层回归模型被用来确定这些质量指标随着时间的推移，当控制组织特征的城乡差异。结果农村机构不太可能是以营利为目的和认证，更有可能是医院为基础，服务于医疗保险和医疗补助受益人，并有临终关怀计划。随着时间的推移，农村机构在及时启动护理方面始终优于城市机构，随着时间的推移，城市机构在住院和艾德就诊方面始终优于城市机构。农村和城市机构之间的这些差距随着时间的推移是稳定的，但住院方面的差距随着时间的推移略有缩小（Coef. = 0.11，P = 0.001（城市和年份相互作用项）。结论农村和城市家庭卫生服务机构的服务质量存在显著差异，但这种差异并没有随着时间的推移而明显缩小。为缩小城乡差距，决策者在作出决策时应考虑到城市和农村机构面临的独特挑战。
Purpose Home health care is one of the fastest growing health care sectors in the United States. However, little is known of differences in trends in quality performance between rural and urban home health agencies over time. This study aimed to examine disparities in quality performance between rural and urban home health agencies between 2014 and 2018. Methods This is a cohort study using 2014-2018 national Home Health Compare data and Providers of Service Profile data, including 7,908 home health agencies, of which 1,537 were rural agencies. Quality performance measures included timely initiation of care, hospitalization, and emergency department (ED) visits. Two-level hierarchical regression models were used to identify rural-urban differences in these quality indicators over time when controlling organizational characteristics. Findings Rural agencies were less likely to be for-profit and accredited, and more likely to be hospital-based, serve both Medicare and Medicaid beneficiaries, and have hospice programs. Rural agencies consistently outperformed on timely initiation of care over time, and urban agencies consistently outperformed on hospitalization and ED visits over time. These gaps between rural and urban agencies were steady over time except the gap in hospitalization, which slightly narrowed over time (Coef. = 0.11, P = .001 for urban and year interaction term). Conclusions Significant differences exist in quality of care between rural and urban home health agencies and such differences have not been significantly narrowed over time. To reduce rural-urban disparities, policy makers should take into account unique challenges faced by urban and rural agencies when making policy decisions.