Disparities in Access to High-Quality Home Health and the Impact of Public Reporting

获得高质量家庭健康的差异以及公共报告的影响

• 批准号: 10041137
• 负责人: Shekinah Antoinette Fashaw-Walters
• 金额: $ 5.34万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10041137
• 关键词: Aging; Caring; Censuses; Characteristics; Data; Data Set; Data Sources; Elderly; Enrollment; Ensure; Ethnic Origin; Geography; Goals; Growth; Health; Health Services; Health Services Accessibility; Health Status; Home Care Services; Home Health Agency; Home environment; Impaired cognition; Improve Access; Incentives; Individual; Intervention; Knowledge; Link; Long-Term Care; Low income; Measures; Medicare; Minority; Mission; Modeling; National Institute on Aging; Neighborhoods; Nursing Homes; Outcome; Outcome Assessment; Patients; Policy Making; Population; Population Heterogeneity; Poverty; Public Health; Quality of Care; Quality of life; Race; Reporting; Research; Research Design; Scientist; Services; Socioeconomic Status; Standardization; Statistical Models; Strategic Planning; System; Time; Underserved Population; United States Centers for Medicare and Medicaid Services; Vulnerable Populations; Work; base; beneficiary; care delivery; career; cost; ethnic minority population; geographic difference; health disparity; health equity; improved; innovation; low socioeconomic status; neighborhood disadvantage; patient response; racial and ethnic; racial and ethnic disparities; web site

PROJECT SUMMARY Although the Centers for Medicare and Medicaid Services (CMS) spends over $18 billion annually to care for approximately 3.4 million home health (HH) beneficiaries, little is known about access to HH for vulnerable populations (i.e., racial/ethnic minorities, low-income older adults, and older adults living in high minority and/or high poverty neighborhoods.) Prior research shows that lower quality home health agencies (HHAs) have higher proportions of minorities, low-income older adults, and beneficiaries from low-income neighborhoods. Reasons for these findings are not well understood, but they may be associated with disparate availability of high-quality HH for underserved populations. Additionally, there is limited information about whether or not current public reporting strategies (i.e., HHCompare Five-Star Ratings) have impacted access to HH or exacerbated disparities in access to HH. The long-term goal of this research is to ensure access to high-quality long-term services and supports for older adults in order to improve older adults' quality of life and care, regardless of individual- and neighborhood-level attributes. The first step towards this goal, and the overall objective of this application is to use national administrative datasets (e.g., standardized HH patient assessment data) to analyze differences in access to high-quality HH care for vulnerable older adults and to understand if and how public reporting influences patients' access to high-quality services. The central hypotheses are that low-income and racial/ethnic minority older adults, as well as beneficiaries living in vulnerable neighborhoods, are more likely to have lower access to high-quality HHAs as compared to their white, more affluent counterparts; and that HHCompare Five- Star ratings will negatively impact access for these underserved populations. To evaluate these hypotheses, the following specific aims are proposed: 1) Assess the impact of individual- and neighborhood-level factors on the utilization of high-quality HHAs among older racial/ethnic minorities and low-income older adults; and 2) Evaluate the differential impact of the HHCompare Five-Star ratings on the utilization of high-quality HHAs for vulnerable populations. To achieve these objectives, this study examines the national population of Medicare beneficiaries receiving HH care between 2012 and 2017 using enrollment, HH Outcome and Assessment Information Set (OASIS), HHCompare, and Census data. The proposed work is innovative because 1) few studies examine HH disparities, 2) this is the first study to examine HHA and patient response to public reporting of quality summary measures, 3) it will link several national data sources, and 4) it will utilize models that jointly consider the relative influence of individual- and neighborhood-level effects. This work is significant because understanding within- (individual-level) and across-neighborhood disparities in access to high-quality HH, over time, can guide interventions and policy-making aimed at decreasing these disparities. This work is time sensitive and significant as it will generate critical evidence on how recent public reporting combined with individual attributes and neighborhood characteristics impact access to high-quality HH for vulnerable populations.

项目摘要 尽管医疗保险和医疗补助服务中心（CMS）每年花费超过180亿美元来照顾 大约340万家庭健康（HH）受益人，对弱势群体获得HH的情况知之甚少 群体（即，少数种族/族裔、低收入老年人和生活在少数民族和/或 （贫困地区）。先前的研究表明，质量较低的家庭健康机构（HHA） 少数民族、低收入老年人和低收入社区受益人的比例。原因 这些发现还没有得到很好的理解，但它们可能与高质量的 HH代表服务不足的人群。此外，关于当前公众是否 报告策略（即，HHCompare五星评级）影响了对HH的访问或加剧了差异 进入HH。这项研究的长期目标是确保获得高质量的长期服务， 为老年人提供支助，以改善老年人的生活质量和护理，无论个人情况如何， 邻居级属性。实现这一目标的第一步，以及本申请的总体目标是 使用国家行政数据集（例如，标准化HH患者评估数据），以分析 为弱势老年人提供高质量的HH护理，并了解是否以及如何公开报告 影响患者获得高质量服务。核心假设是，低收入和种族/族裔 少数老年人，以及生活在脆弱社区的受益人，更有可能有较低的 获得高质量的HHA相比，他们的白色，更富裕的同行;和HHCompare五- 星星评级将对这些得不到充分服务的人口的获得产生负面影响。为了评估这些假设， 提出了以下具体目标：1）评估个人和邻里水平因素对 在老年种族/少数民族和低收入老年人中使用高质量的HHA;以及2）评估 HHCompare五星评级对弱势群体利用高质量HHA的不同影响 人口。为了实现这些目标，本研究调查了全国医疗保险受益人的人口 使用入组、HH结局和评估信息集，在2012年至2017年期间接受HH护理 （OASIS），HHCompare和Census数据。建议的工作是创新的，因为1）很少有研究检查HH 差异，2）这是第一项研究，以检查HHA和病人的反应，以公众报告的质量摘要 3）它将连接几个国家数据源，4）它将利用共同考虑相对 个人和邻里水平的影响。这项工作意义重大，因为了解- 随着时间的推移，在获得高质量HH方面的（个人水平）和跨社区差异可以指导 旨在缩小这些差距的干预和决策。这项工作时间紧迫，意义重大 因为它将产生关于最近的公开报道如何与个人属性相结合的关键证据， 邻里特征影响弱势群体获得高质量的HH。