Division of General Internal Medicine and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Institute for Health, Health Care Policy, and Aging Research, Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers University, Rutgers, NJ, USA.
J Am Med Dir Assoc. 2024 Jun;25(6):104983. doi: 10.1016/j.jamda.2024.03.003. Epub 2024 Apr 8.
Medicare Home Health Care (HHC) services are integral to the care of homebound seriously ill older adults requiring ongoing specialized medical care. Although disparities in health outcomes are well documented in inpatient and primary care, disparities experienced by historically marginalized racial and ethnic groups underrepresented in HHC are understudied. This study aimed to examine the relationship between individual characteristics and differences in HHC health outcomes for seriously ill older adults.
Secondary data analysis, repeated measure.
Seriously ill older adults who received HHC in 2016 in the HHC Outcome and Assessment Information Set (OASIS).
Start of care and discharge data from the 2016 HCC OASIS were used to examine the relationship between individual characteristics and differences in HHC health outcomes identified by the Centers for Medicare and Medicaid Services as key indicators of quality in HHC, including dyspnea, pain frequency, cognitive functioning, and presence of unhealed pressure ulcer stage II or higher. A generalized ordered logit model with partial proportional odds was used for the ordinal categorical outcomes and a logistic regression was used for the binary dependent variable.
Findings indicated that of 227,402 seriously ill individuals with an HHC episode in 2016, those from underrepresented racial and ethnic groups had between 14% and 57% higher odds of worse health outcomes compared with non-Hispanic white patients with the exception of pain frequency.
For people living with serious illness, there are significant differences in Medicare HHC health outcomes when comparing underrepresented racial or ethnic beneficiaries with white counterparts. More research is needed to understand how health care processes such as referral patterns or time to care initiation, and structural factors such as HHC agency quality and neighborhood social deprivation are related to health differences observed in the population.
医疗保险家庭保健（HHC）服务是照顾需要持续专业医疗护理的居家重病老年人的重要组成部分。尽管在住院和初级保健方面，健康结果的差异有充分的记录，但在 HHC 中代表性不足的历史上被边缘化的种族和族裔群体所经历的差异研究较少。本研究旨在研究个人特征与重病老年人 HHC 健康结果差异之间的关系。
二次数据分析，重复测量。
2016 年在 HHC 结局和评估信息集（OASIS）中接受 HHC 的重病老年人。
使用 2016 年 HCC OASIS 的开始护理和出院数据，研究个人特征与医疗保险和医疗补助服务中心确定的 HHC 健康结果差异之间的关系，这些差异是 HHC 质量的关键指标，包括呼吸困难、疼痛频率、认知功能和未愈合的 II 期或更高压疮的存在。使用部分比例优势广义有序逻辑模型对有序分类结果进行分析，使用逻辑回归对二项依赖变量进行分析。
研究结果表明，在 2016 年有 HHC 发作的 227402 名重病患者中，除疼痛频率外，代表人数不足的种族和族裔群体的健康结果较差的可能性比非西班牙裔白人患者高 14%至 57%。
对于患有严重疾病的人来说，在比较代表性不足的种族或族裔受益人与白人患者时，医疗保险 HHC 的健康结果存在显著差异。需要更多的研究来了解医疗保健流程（如转诊模式或护理启动时间）和结构因素（如 HHC 机构质量和邻里社会贫困）如何与人群中观察到的健康差异相关。
