Development and Testing of Health Equity Measures in Home Health Care for Medicare Beneficiaries

项目摘要 家庭医疗保健是医疗保险计划下的一项基本医疗保健服务和福利， 旨在改善健康结果，减少可避免的住院，并减少机构安置。 种族和少数民族医疗保险受益人利用家庭保健的比率高于 全民医疗尽管近年来家庭健康的增长和使用增加， 家庭健康机构组织结构在家庭健康质量中的作用的证据很少， 股权对为少数群体服务的家庭保健机构的了解也存在差距。大多数“高少数群体” 机构被CMS评为质量较低;然而，他们也可能提供文化和语言 适当的护理应与最佳结果和最高质量的护理相关联。这一悖论 将使用基于优势的方法进行探索，以了解与高品质家居相关的因素 总体上，在少数民族服务的背景下，种族和少数民族患者的医疗保健结果 家庭保健机构。拟议项目的总体目标是建立家庭保健程序， 通过计算种族和族裔特定的质量评级来衡量结果公平， 家庭保健机构的组织特点，最高的评级和那些最高的 有色人种患者的比例。从这个项目中产生的证据将是重要的第一步（1）创建 更好的衡量健康公平的标准，以边缘化人群为中心，（2）设计和评估健康 系统和政策干预措施，以消除基本家庭保健服务方面的不公平现象。 根据Donabedian的结构-过程-结果框架，种族和民族特定的家庭健康 质量评级将计算护理过程和中心使用的结果指标， 医疗保险和医疗补助服务（CMS）星星评级。这项研究将匹配，合并和链接国家医疗保险 受益人的行政、家庭医疗保健评估和住院索赔数据与家庭医疗保健 机构级CMS护理比较数据以评估家庭卫生机构内护理质量的种族不平等 通过两个目标的结果：（1）组成和展示种族和族裔群体的具体家园的效用 卫生机构质量评级，采用CMS Care Compare使用的方法。我们将评估效用 新的针对种族和族裔的措施与原来的全面措施相比， 计算可靠性和信息量指标。(2)评估家庭健康机构结构，作为 家庭保健机构过程和结果的质量和公平。家庭保健机构的结构因素（例如， 少数民族服务，规模，任期，所有权，农村）将被用来预测种族和民族的具体照顾 质量过程（即，及时开始护理）和结果测量（例如，功能改进， 住院）。这项工作既及时又重要，有可能深刻影响质量， 家庭保健和其他保健部门内的保健公平性衡量。

PROJECT SUMMARY Home health care is an essential healthcare service and benefit under the Medicare insurance programs, aimed to improve health outcomes, reduce avoidable hospitalizations, and decrease institutional placements. Racial and ethnic minority Medicare beneficiaries utilize home health care at higher-rates compared to the general Medicare population. Despite the growth and increased use of home health in recent years, there is little evidence about the role of home health agency organizational structures in home health quality and equity. There is also a gap in knowledge about minority-serving home health agencies. Most “high-minority” agencies are rated as lower quality by CMS; however, they may also provide culturally and linguistically appropriate care that should be associated with the best outcomes and highest quality of care. This paradox will be explored using a strengths-based approach, to understand factors associated with high-quality home health care outcomes for racial- and ethnic minority patients overall, and within the context of minority-serving home health agencies. The overall objective of the proposed project is to create home health process and outcome equity measures by calculating race- and ethnicity-specific quality ratings to examine the organizational characteristics of home health agencies with the highest ratings and those with the highest share of patients of color. The evidence generated from this project will be an important first step in (1) creating better measures of health equity that center marginalized populations, and (2) designing and evaluating health systems and policy interventions with the goal of eliminating inequities in essential home health services. Informed by Donabedian’s Structure-Process-Outcomes framework, race- and ethnicity-specific home health quality ratings will be calculated for the process of care and outcome measures used in the Centers for Medicare and Medicaid Services (CMS) star ratings. This study will match, merge, and link national Medicare beneficiaries’ administrative, home health care assessment, and inpatient claims data with home health agency level CMS Care Compare data to evaluate within-home health agency racial inequities in care quality outcomes through two aims: (1) Compose and demonstrate the utility of race and ethnic group-specific home health agency quality ratings, adapting the methodology used by CMS Care Compare. We will evaluate utility of the new race- and ethnicity-specific measures in comparison to the original, overall measures through the calculation of reliability and informativeness metrics. (2) Assess home health agency structure as a predictor of quality and equity in home health agency process and outcomes. Home health agency structural factors (e.g., minority-serving, size, tenure, ownership, rurality) will be used to predict race- and ethnicity-specific care quality process (i.e., timely initiation of care) and outcome measures (e.g., functional improvements, hospitalizations). This work is both timely and significant, with the potential to profoundly impact quality and health equity measurement within home health and other healthcare sectors.