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

项目总结 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)受益者，对弱势群体获得HH的机会知之甚少 人口(即种族/族裔少数群体、低收入老年人和生活在少数族裔和/或高收入群体的老年人 高度贫困社区。)先前的研究表明，质量较低的家庭健康机构(Hha)拥有更高的 少数民族、低收入老年人和低收入社区受益者的比例。原因 因为这些发现还不是很清楚，但它们可能与高质量的不同可获得性有关 HH针对服务不足的人群。此外，关于当前公开的 报告策略(即HHCompare五星评级)影响了HH的获取或加剧了差异 进入HH的通道。这项研究的长期目标是确保获得高质量的长期服务和 为老年人提供支持，以改善老年人的生活质量和护理，不分个人--以及 邻域级别的属性。迈向这一目标的第一步，也是本应用程序的总体目标是 使用国家行政数据集(例如，标准化的HH患者评估数据)来分析 为易受伤害的老年人提供高质量的保健服务，并了解公共报告是否以及如何 影响患者获得高质量服务的机会。中心假设是低收入和种族/民族 少数族裔老年人以及生活在脆弱社区的受益者更有可能拥有较低的收入 与白人、更富裕的同龄人相比，获得高质量的HHA的机会；HHCOMPARE 5- 星级评级将对这些服务不足的人群的准入产生负面影响。为了评估这些假设， 提出了以下具体目标：1)评估个人和邻里层面因素对 在老年种族/族裔少数群体和低收入老年人中利用高质量的卫生和卫生设施；以及2)评估 HHCompare五星评级对弱势群体利用优质HHA的差异性影响 人口。为了实现这些目标，这项研究调查了医疗保险受益人的全国人口 2012至2017年间使用登记、HH结果和评估信息集接受HH护理 (OASIS)、HHCompare和人口普查数据。这项拟议的工作是创新的，因为1)很少有研究研究HH 差异，2)这是第一项检查HHA和患者对公众报告质量总结的反应的研究 措施，3)它将连接几个国家数据来源，4)它将利用联合考虑相对的模型 个人和邻里层面效应的影响。这项工作意义重大，因为了解- (个人层面)和跨社区获得高质量卫生保健服务的差距，随着时间的推移，可以指导 旨在缩小这些差距的干预和政策制定。这项工作具有时间敏感性和重要意义。 因为它将产生关键证据，说明最近的公共报道如何与个人属性和 社区特征影响弱势群体获得高质量的卫生保健服务。

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.