Wang Yun, Leifheit-Limson Erica C, Fine Jonathan, Pandolfi Michelle M, Gao Yan, Liu Fanglin, Eckenrode Sheila, Lichtman Judith H
Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Center for Outcomes Research and Evaluation, Yale University and Yale-New Haven Hospital, New Haven, Connecticut.
J Am Geriatr Soc. 2017 Jul;65(7):1434-1440. doi: 10.1111/jgs.14811. Epub 2017 Mar 21.
To evaluate national trends and geographic variation in the availability of home health care from 2002 to 2015 and identify county-specific characteristics associated with home health care.
Observational study.
All counties in the United States.
All Medicare-certified home health agencies included in the Centers for Medicare & Medicaid Services Home Health Compare system.
County-specific availability of home health care, defined as the number of available home health agencies that provided services to a given county per 100,000 population aged ≥18 years.
The study included 15,184 Medicare-certified home health agencies that served 97% of U.S. ZIP codes. Between 2002-2003 and 2014-2015, the county-specific number of available home health agencies per 100,000 population aged ≥18 years increased from 14.7 to 21.8 and the median (inter-quartile range) population that was serviced by at least one home health agency increased from 403,605 (890,329) to 455,488 (1,039,328). Considerable geographic variation in the availability of home health care was observed. The West, North East, and South Atlantic regions had lower home health care availability than the Central regions, and this pattern persisted over the study period. Counties with higher median income, a larger senior population, higher rates of households without a car and low access to stores, more obesity, greater inactivity, and higher proportions of non-Hispanic white, non-Hispanic black, and Hispanic populations were more likely to have higher availability of home health care.
The availability of home health care increased nationwide during the study period, but there was much geographic variation.
评估2002年至2015年全国范围内家庭医疗保健服务的趋势和地理差异，并确定与家庭医疗保健相关的特定县特征。
观察性研究。
美国所有县。
医疗保险和医疗补助服务中心家庭医疗比较系统中所有获得医疗保险认证的家庭医疗机构。
特定县的家庭医疗保健服务可及性，定义为每10万≥18岁人口中为给定县提供服务的可用家庭医疗机构数量。
该研究纳入了15184家获得医疗保险认证的家庭医疗机构，这些机构服务了97%的美国邮政编码区域。在2002 - 2003年至2014 - 2015年期间，每10万≥18岁人口中可用家庭医疗机构的特定县数量从14.7增加到21.8，至少由一家家庭医疗机构服务的人口中位数（四分位间距）从403605（890329）增加到455488（1039328）。观察到家庭医疗保健服务可及性存在显著的地理差异。西部、东北部和南大西洋地区的家庭医疗保健服务可及性低于中部地区，且这种模式在研究期间持续存在。收入中位数较高、老年人口较多、无车家庭比例较高且购物不便、肥胖率更高、缺乏运动以及非西班牙裔白人、非西班牙裔黑人和西班牙裔人口比例更高的县，家庭医疗保健服务可及性更有可能更高。
在研究期间，全国范围内家庭医疗保健服务的可及性有所增加，但存在很大的地理差异。
