Business Intelligence and Analytics, VNS Health, New York, New York, USA.
Center for Home Care Policy and Research, VNS Health, New York, New York, USA.
Gerontologist. 2023 Aug 24;63(7):1117-1128. doi: 10.1093/geront/gnac113.
Demands for home-based care have surged alongside population aging, preferences for aging in place, policy-driven reforms incentivizing lower hospital utilization, and public concerns around coronavirus disease 2019 transmissions in institutional care settings. However, at both macro and micro levels, sociopolitical, and infrastructural contexts are not aligned with the operational needs of home health care organizations, presenting obstacles to home health care equity. We integrate the social-ecological model and organizational theory to highlight contextual forces shaping the delivery of home-based care services between 2010 and 2020. Placing home-based health care organizations at the center of observation, we discuss patterns and trends of service delivery as systematic organizational behaviors reflecting the organizations' adaptations and responses to their surrounding forces. In this light, we consider the implications of provision and access to home care services for health equity, discuss topics that are understudied, and provide recommendations for home-based health care organizations to advance home health care equity. The article represents a synthesis of recent literature and our research and industry experiences.
随着人口老龄化、就地养老偏好、政策驱动的改革鼓励降低医院利用率以及公众对 2019 年冠状病毒病在机构护理环境中传播的担忧，对家庭护理的需求激增。然而，在宏观和微观层面上，社会政治和基础设施环境与家庭保健组织的运营需求并不一致，这给家庭保健公平带来了障碍。我们整合了社会生态模型和组织理论，以突出塑造 2010 年至 2020 年期间家庭护理服务提供的背景力量。将家庭保健组织置于观察中心，我们讨论了服务提供的模式和趋势，这些模式和趋势是反映组织对周围力量的适应和反应的系统组织行为。有鉴于此，我们考虑了提供和获得家庭护理服务对健康公平的影响，讨论了研究不足的话题，并为家庭保健组织提供了推进家庭保健公平的建议。本文综合了最近的文献以及我们的研究和行业经验。
