scholarly journals Home Health Agencies With More Socially Vulnerable Patients Have Lower Experience-of-Care Ratings

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 535-536
Author(s):  
Jinjiao Wang ◽  
Meiling Ying ◽  
Yue Li
Keyword(s):  
Ethnic Minorities ◽  
Patient Experience ◽  
Care Delivery ◽  
Effective Communication ◽  
Home Health ◽  
Experience Of Care ◽  
Vulnerable Patients ◽  
Dual Eligible ◽  
Professional Care ◽  
Racial Ethnic

Abstract Little is known about the disparities in patient experience of home health (HH) care related to social vulnerability. This study examined the relationships of patient Medicare-Medicaid dual eligible status and race and ethnicity with patient experience of HH care. We analyzed national data from the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS), Outcome and Assessment Information Set, Medicare claims and Area Health Resources File for 11,137 Medicare-certified HH agencies (HHA) that provided care for Medicare beneficiaries in 2017. Patient-reported experience of care star ratings (1-5) in HHCAHPS included 3 domains (professional care delivery, effective communication, and specific issues in direct patient care) with each dichotomized into high (4-5) and low (1-3) experience of care. The proportion of patients with dual eligibility and the proportion of racial/ethnic minorities were summarized at the HHA level. HHA with higher proportion of dual eligible patients were less likely to have high experience of care rating in professional care delivery (smallest Odds Ratio [OR]=0.514; 95% CI: 0.397, 0.665; p<0.001), effective communication (smallest OR=0.442, 95% CI: 0.336, 0.583; p<0.001), and specific direct care issues (smallest OR=0.697, 95% CI: 0.540, 0.899; p=0.006). HHA with higher proportion of racial/ethnic minorities were also less likely to have high patient experience of care rating across all three domains (smallest OR=0.265, 95% CI: 0.189, 0.370; p<0.001). Disparities in patient experience of HH care exist and they are associated with low income and racial/ethnic minority status, indicating substantial unmet needs among these socially vulnerable patients.

scholarly journals Home Health Agencies With More Socially Vulnerable Patients Have Poorer Experience of Care Ratings

2021 ◽  
pp. 073346482110538
Author(s):  
Jinjiao Wang ◽  
Meiling Ying ◽  
Yue Li
Keyword(s):  
Ethnic Minorities ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Home Health ◽  
Experience Of Care ◽  
Health Agencies ◽  
Dual Eligible ◽  
Home Health Agencies ◽  
Specific Care ◽  
Racial Ethnic

Objectives Examine the relationships between dual eligibility and race/ethnicity characteristics of Medicare-Certified Home Health Agencies (CHHAs) and experience of care ratings. Methods Analysis of 2017 national Consumer Assessment of Healthcare Providers and Systems and matched datasets of 10,906 CHHAs Results CHHAs with higher concentrations of dual-eligible patients were less likely to have high experience of care ratings for all three domains (e.g., for care delivery, quartile 4 vs. 1: odds ratio [OR] = 0.622, p < .001); CHHAs with higher concentrations of racial/ethnic minorities generally were less likely to have high experience of care ratings in care delivery (e.g., Black: quartile 4 vs. 1: OR = 0.418, p<0.001), communication (e.g., Black: quartile 4 vs. 1: OR = 0.316, p<0.001), and specific care issues (e.g., Hispanic: quartile 4 vs. 1: OR = 0.397, p < .001). Discussion CHHAs with greater concentrations of dual-eligible patients and racial/ethnic minorities were more likely to have poor experience of care ratings.

scholarly journals Associations Between Nonclinical Services and Patient-Experience Outcomes in US Acute Care Hospitals

2019 ◽  
Vol 7 (6) ◽  
pp. 1086-1093
Author(s):  
Melody K Schiaffino ◽  
Yukari Suzuki ◽  
Tarryn Ho ◽  
Tracy L Finlayson ◽  
Jeffrey S Harman
Keyword(s):  
Patient Education ◽  
Patient Experience ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Organizational Factors ◽  
Relevant Information ◽  
Full Time ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Experience Of Care

Background: Patient experience is an important measure of hospital quality and performance. Since the passage of the Affordable Care Act, patient experiences with their care encounters are embedded into the framework of payment incentives. However, drivers of patient experience in the context of the supportive, nonclinical, services that relate to patient care have not been as well understood. Aims: To assess the role of organizational factors on patient experience. Methods: This cross-sectional analysis integrates hospital patient-experience scores from Hospital Consumer Assessment of Healthcare Providers and Systems, and Centers for Medicaid and Medicare Service data from 2013 to 2015 (N = 3392). Based on hospitals with “top-box” responses, the aggregate proportion of hospital patients responding “always” on a Likert scale represented a top-box hospital. Domains were split at the mean for analysis (above average = 1). Multivariable logistic regression models for each domain were analyzed against hospital factors and services, including offering a patient education center, patient-enabling services, and language services. Results: Most hospitals reported a full-time hospitalist (64.4%) and a patient education center (60.4%), while fewer provided enabling/support services (33.7%). In multivariable models, small and medium hospitals performed better compared to the largest hospitals (300+ beds; P < .0001). Structurally, medium and small hospitals reported significantly greater odds of top-box patient-experience versus large hospitals. Across all domains, only hospitals with patient education centers returned better performance (adjusted odds ratio: 1.27-1.64; P = .0002-.0166). Discussion/Conclusion: Patient education centers provide relevant information at the point of service and may improve overall patient experience of care. Given the growing reliance on accountable care delivery models, opportunities to partner with community health education partners may be profitable.

scholarly journals Do Gender-Predominant Primary Health Care Organizations Have an Impact on Patient Experience of Care, Use of Services, and Unmet Needs?

2017 ◽  
Vol 54 ◽  
pp. 004695801770968 ◽  
Author(s):  
Raynald Pineault ◽  
Roxane Borgès Da Silva ◽  
Sylvie Provost ◽  
Michel Fournier ◽  
Alexandre Prud’homme ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Patient Experience ◽  
Unmet Needs ◽  
Care Delivery ◽  
Care Organization ◽  
Experience Of Care ◽  
Primary Health ◽  
Use Of Services ◽  
The Impact

Physicians’ gender can have an impact on many aspects of patient experience of care. Organization processes through which the influence of gender is exerted have not been fully explored. The aim of this article is to compare primary health care (PHC) organizations in which female or male doctors are predominant regarding organization and patient characteristics, and to assess their influence on experience of care, preventive care delivery, use of services, and unmet needs. In 2010, we conducted surveys of a population stratified sample (N = 9180) and of all PHC organizations (N = 606) in 2 regions of the province of Québec, Canada. Patient and organization variables were entered sequentially into multilevel regression analyses to measure the impact of gender predominance. Female-predominant organizations had younger doctors and nurses with more expanded role; they collaborated more with other PHC practices, used more tools for prevention, and allotted more time to patient visits. However, doctors spent fewer hours a week at the practice in female-predominant organizations. Patients of these organizations reported lower accessibility. Conversely, they reported better comprehensiveness, responsiveness, counseling, and screening, but these effects were mainly attributable to doctors’ younger age. Their reporting unmet needs and emergency department attendance tended to decrease when controlling for patient and organization variables other than doctors’ age. Except for accessibility, female-predominant PHC organizations are comparable with their male counterparts. Mean age of doctors was an important confounding variable that mitigated differences, whereas other organization variables enhanced them. These findings deserve consideration to better understand and assess the impacts of the growing number of female-predominant PHC organizations on the health care system.

scholarly journals Albuminuria Testing by Race and Ethnicity among Patients with Hypertension with and without Diabetes

2019 ◽  
Vol 50 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Joi Lee ◽  
Chi Chu ◽  
David Guzman ◽  
Valy Fontil ◽  
Alexandra Velasquez ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Kidney Disease ◽  
Ethnic Minorities ◽  
Health Care Delivery ◽  
Low Income ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Public Health Care ◽  
Racial Ethnic

Background: Detection of chronic kidney disease (CKD) with urine albumin-to-creatinine ratio (UACR) among patients with hypertension (HTN) provides an opportunity for early treatment, potentially mitigating risk of CKD progression and cardiovascular complications. Differences in UACR testing patterns among racial/ethnic populations at risk for CKD could contribute to known disparities in CKD complications. Methods: We examined the prevalence of UACR testing among low-income adult primary care patients with HTN, defined by a new administrative code for HTN or 2 clinic blood pressures >140/90 mm Hg between January 1, 2014, and January 1, 2017, in one public health-care delivery system with a high prevalence of end-stage kidney disease among race/ethnic minorities. Logistic regression was used to identify odds of UACR testing within 1 year of a HTN diagnosis, overall, and by racial/ethnic subgroup, adjusted for demographic factors, estimated glomerular filtration rate, and HTN severity. Models were also stratified by diabetes status. Results: The cohort (n = 16,414) was racially/ethnically diverse (16% White, 21% Black, 34% Asian, 19% Hispanic, and 10% other) and 51% female. Only 35% of patients had UACR testing within 1 year of a HTN diagnosis. Among individuals without diabetes, odds of UACR testing were higher among Asians, Blacks, and Other subgroups compared to Whites (adjusted OR [aOR] 1.19; 95% CI 1.00–1.42 for Blacks; aOR 1.33; 1.13–1.56 for Asians; aOR 1.30; 1.04–1.60 for Other) but were not significantly different between Hispanics and Whites (aOR 1.17; 0.97–1.39). Among individuals with diabetes, only Asians had higher odds of UACR testing compared to Whites (aOR 1.35; 1.12–1.63). Conclusions: Prevalence of UACR testing among low-income patients with HTN is low in one public health-care delivery system, with higher odds of UACR testing among racial/ethnic minority subgroups compared to Whites without diabetes and similar odds among those with diabetes. If generalizable, less albuminuria testing may not explain higher prevalence of kidney failure in racial/ethnic minorities.

A scoping review of patients’ perception of electronic medical record implementation in the emergency department (Preprint)

2020 ◽  
Author(s):  
Mingshuang Ding
Keyword(s):  
Emergency Department ◽  
Patient Experience ◽  
Scoping Review ◽  
Care Delivery ◽  
Patient Perception ◽  
Patient Perceptions ◽  
Hospital Environment ◽  
Cochrane Library ◽  
Clinical Environment ◽  
Experience Of Care

BACKGROUND Providing a satisfactory patient experience in the hospital environment is an important component of quality, patient-centred healthcare. The Emergency Department (ED) is a unique clinical environment characterised by a high workload, high cognitive load, tight time constraints and a lack of prolonged clinician–patient relationship development. In this environment, it is often a challenge for clinicians to maintain effective patient communication, which may impact negatively upon patients’ experiences of healthcare. The increasing adoption of electronic medical records (EMR) throughout EDs is changing clinical workflows and, as such, also has the potential to impact patient perceptions of healthcare. OBJECTIVE The purpose of this scoping review was to explore patients’ perceptions of EMR implementation in EDs nationally and internationally. METHODS A scoping review was conducted using the Arksey and O’Malley framework. Examination of databases including: PubMed, CINAHL, Embase, Medline, Cochrane library and PsycINFO using a string of search terms around EMR and patient perception/satisfaction initially revealed 3858 articles for screening. RESULTS Only 2 studies met the inclusion criteria of examining an aspect of patient perception of EMRs in EDs. These showed mixed impacts of EMR implementation on patient experience. Broadening the frame of the scoping review to include other areas in hospitals did, however, reveal additional studies exploring patient perceptions of EMRs which can be used as a framework for further research in the ED. CONCLUSIONS We proposed further investigation into patients’ perceptions of implementation and clinician use of EMRs in EDs is essential to ensure quality patient experience of care delivery. CLINICALTRIAL N/A

The State of Asian American Businesses

2011 ◽  
Vol 9 (1-2) ◽  
pp. 70-77
Author(s):  
Diem Tran ◽  
OiYan Poon
Keyword(s):  
Ethnic Minorities ◽  
Asian American ◽  
The State ◽  
Business Success ◽  
American Business ◽  
Policy Recommendations ◽  
Business Ownership ◽  
Careful Scrutiny ◽  
Potential Factors ◽  
Racial Ethnic

Business success is a dominant theme in the Asian American narrative. However, Asian American entrepreneurship is more complex and multilayered than commonly believed and requires careful scrutiny. This brief examines the state of Asian American business ownership between 2005 and 2007. Findings suggest that although Asian Americans form businesses at higher rates than other racial/ethnic minorities, Asian American business ownership and outcomes continue to trail those of non-Hispanic whites. Potential factors contributing to racial/ethnic gaps and policy recommendations are discussed.

Home Health Agencies: Empirical Evidence on the Patient-Driven Groupings Model’s Expected Effects on Agency Reimbursements

2021 ◽  
pp. 108482232199038
Author(s):  
Elizabeth Plummer ◽  
William F. Wempe
Keyword(s):  
Ordinary Least Squares ◽  
Process Quality ◽  
Home Health ◽  
Least Squares Regression ◽  
Residual Variation ◽  
Health Agencies ◽  
Dual Eligible ◽  
Home Health Agencies ◽  
Seriously Ill Patients ◽  
Seriously Ill

Beginning January 1, 2020, Medicare’s Patient-Driven Groupings Model (PDGM) eliminated therapy as a direct determinant of Home Health Agencies’ (HHAs’) reimbursements. Instead, PDGM advances Medicare’s shift toward value-based payment models by directly linking HHAs’ reimbursements to patients’ medical conditions. We use 3 publicly-available datasets and ordered logistic regression to examine the associations between HHAs’ pre-PDGM provision of therapy and their other agency, patient, and quality characteristics. Our study therefore provides evidence on PDGM’s likely effects on HHA reimbursements assuming current patient populations and service levels do not change. We find that PDGM will likely increase payments to rural and facility-based HHAs, as well as HHAs serving greater proportions of non-white, dual-eligible, and seriously ill patients. Payments will also increase for HHAs scoring higher on quality surveys, but decrease for HHAs with higher outcome and process quality scores. We also use ordinary least squares regression to examine residual variation in HHAs’ expected reimbursement changes under PDGM, after accounting for any expected changes related to their pre-PDGM levels of therapy provision. We find that larger and rural HHAs will likely experience residual payment increases under PDGM, as will HHAs with greater numbers of seriously ill, younger, and non-white patients. HHAs with higher process quality, but lower outcome quality, will similarly benefit from PDGM. Understanding how PDGM affects HHAs is crucial as policymakers seek ways to increase equitable access to safe and affordable non-facility-provided healthcare that provides appropriate levels of therapy, nursing, and other care.

scholarly journals Description, Health Care Utilization, and Outcomes for Home Health Care (HHC) COVID-19 Patients Early in the Pandemic: A Comparison to the General HHC Population

2021 ◽  
pp. 108482232110013
Author(s):  
Tami M. Videon ◽  
Robert J. Rosati ◽  
Steven H. Landers
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Home Health Care ◽  
Private Insurance ◽  
Health Agency ◽  
Home Health ◽  
Care Utilization ◽  
Observational Cohort ◽  
Racial Ethnic ◽  
Retrospective Observational Cohort Study

COVID-19 patients represent a new and distinct population in home health care. Little is known about health care utilization and incremental improvements in health for recovering COVID-19 patients after admission to home health care. Using a retrospective observational cohort study of 5452 episodes of home health care admitted to a New Jersey Home Health Agency between March 15 and May 31, 2020, this study describes COVID-19 Home Health Care (HHC) patients ( n = 842) and compare them to the general HHC population ( n = 4610). COVID HHC patients differ in significant ways from the typical HHC population. COVID patients were more likely to be 65 years of age and younger (41% vs 26%), be from a racial/ethnic minority (60% vs 31%), live with another person (85% vs 76%), have private insurance (28% vs 16%), and began HHC with greater independence in activities-of-daily-living (ADL/IADLs). COVID patients received fewer overall visits than their non-COVID counterparts (11.7 vs 16.3), although they had significantly more remote visits (1.7 vs 0.3). Multivariate analyses show that COVID patients early in the pandemic were 34% (CI, 28%-40%) less likely to be hospitalized and demonstrated significantly greater improvement in all the outcome measures examined compared to the general home health population.

Sign in / Sign up

Export Citation Format

Share Document