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 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&lt;0.001), effective communication (smallest OR=0.442, 95% CI: 0.336, 0.583; p&lt;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&lt;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.

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 Patient-Rated Performance of Home Health Agencies and Hospitalization Risk: A Propensity-Score Matched Analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 536-536
Author(s):  
Chenjuan Ma ◽  
Lisa Groom ◽  
Shih-Yin Lin ◽  
Daniel David ◽  
Abraham Brody
Keyword(s):  
Health Care ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Patient Experience ◽  
Home Health Care ◽  
Healthcare Providers ◽  
Home Health ◽  
High Performing ◽  
Health Agencies ◽  
Home Health Agencies

Abstract Home health care is the most commonly used home- and community-based service to older adults “Aging in Place”. Patient experience of healthcare services is a critical aspect of patient-centered care. Indeed, policymakers have linked patient-rated quality of care to payment to healthcare providers. This study aimed to examine the association between patient-rated care performance of home health agencies and risk for hospitalization among Medicare beneficiaries. This study used several national datasets from 2016 and included 491,718 individuals from 8,459 home health agencies. Home health agencies’ performance was measured using patient experience star rating from the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS). Propensity score matching was used to balance the differences in patient characteristics at baseline between those receiving care from high-performing home health agencies and those in lower-performing agencies. On average, patients were 80.5 years old, 65% female, 81% White, 10% Black, and 6% Hispanic, with 90% taking 5 or more medications. Patients had a mean score of 1.73 (SD=1.69) on the Charlson Index. Respectively, 10% and 16% of patients were hospitalized within 30 and 60 days of home health care initiation. Estimates of logistic regression after propensity score matching found that patients receiving care from lower-performing agencies were at similar risk for both 30-day (OR=0.99, p=0.817) and 60-day (OR=1.02, p=0.616) hospitalization following the start of home health care, compared to those in high-performing agencies. Our findings suggest discrepancies (or no relationship) between patient experience and objective outcomes of home health care.

scholarly journals Inequities in Access to High-Quality Home Health Agencies Among Racial and Ethnic Minorities With and Without Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 330-330
Author(s):  
Bei Wu ◽  
Abraham Brody ◽  
Chenjuan Ma
Keyword(s):  
Ethnic Minorities ◽  
Home Health ◽  
High Quality ◽  
Racial And Ethnic Minorities ◽  
Black And White ◽  
Percentage Points ◽  
Health Agencies ◽  
Home Health Agencies ◽  
Race Ethnicity ◽  
To Receive

Abstract There are rising concerns of inequities in access to high-quality home health agencies (HHA). Using multiple national data sources that included 574,682 individuals from 8,634 HHA, we examined access to high-quality HHA care among racial and ethnic minorities with and without dementia. Approximately 9.9% of the individuals were Black, 6.2% Hispanic, and 3.3% other race/ethnicity. Over one-third (36.3%) had been diagnosed with dementia. Black and Hispanic individuals were 5.5 percentage points (95% CI, 5.2% - 5.9%) and 7.4 percentage points (95% CI, 7.0% - 7.8%) respectively more likely to receive care from agencies defined as having low-quality compared to White counterparts. Persons living with dementia were 1.3% less likely to receive care from high-quality agencies. Having dementia increased the inequity in accessing high-quality HHA between Black and White individuals. Racial and ethnic minorities, particularly those with dementia were at a disadvantaged position to receive care from high-quality HHA.

Association Between the Rate of Diabetes and Quality of Patient Care in Home Health Agencies

2018 ◽  
Vol 31 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Dimitrios Zikos ◽  
Yetunde Ogunneye ◽  
Nailya Delellis ◽  
Lana Ivanitskaya
Keyword(s):  
Home Health Care ◽  
Healthcare Providers ◽  
Primary Diagnosis ◽  
Home Health ◽  
Diabetic Patients ◽  
Health Agencies ◽  
Patients With Diabetes ◽  
Negative Effect ◽  
Information Set ◽  
Home Health Agencies

The multitude of comorbidities and disabilities that are prevalent among diabetic patients make their care very challenging for providers. This, in turn, may have a negative effect on measures of patient satisfaction, quality, and outcomes. This study examines the correlation between diabetes ratio as a primary diagnosis in home health agencies (HHAs) with the Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey and the Outcome and Assessment Information Set (OASIS) star ratings. Our result indicates that HHAs with a higher proportion of patients with diabetes have lower ratings in health outcomes (bathing, breathing, moving from the bed, moving around, and controlling pain). The association was stronger in the case of diabetic cases with complications.

scholarly journals Is Health Information Exchange Use by Hospitals and Home Health Agencies Associated with Lower Readmission Rates?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 914-914
Author(s):  
Christine Jones ◽  
Jacob Thomas ◽  
Marisa Roczen ◽  
Kate Ytell ◽  
Mark Gritz
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Transitional Care ◽  
Care Transitions ◽  
Home Health ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Readmission Rates ◽  
Health Agencies ◽  
Home Health Agencies

Abstract For older adults transitioning from the hospital to home health agencies (HHAs), clinical information exchange is key for optimal transitional care. Hospital and HHA participation in regional health information exchanges (HIEs) could address fragmented communication and improve patient outcomes. We examined differences in characteristics and outcomes for patients with either Medicare or Medicare Advantage (MA) insurance who transitioned from hospitals to HHAs based on HIE participation with 2014-2018 data from the Colorado All Payer Claims Database. We performed analyses including chi square and t tests to compare patient characteristics and 30-day readmission rates for high versus lower HIE use, determined by HIE participation (+) and non-participation (-) among HHAs and hospitals: High HIE use dyads (Hospital+/HHA+) were compared to lower HIE use dyads (Hospital+/HHA-, Hospital-/HHA+, Hospital-/HHA-). We identified 57,998 care transitions from 123 acute care hospitals to 71 HHAs. On average, patients were 75 years old, had a three day hospital length of stay, over half were female (58%), 82% had Medicare and 18% had MA insurance. Although most characteristics were similar between high versus lower HIE use dyads, high HIE use dyads had a higher proportion of Medicare patients compared to the lower HIE use dyads (85% vs 79%, p &lt;0.001). Thirty-day readmissions were 12.4% for care transitions that occurred among high HIE use dyads (n=27,784) compared to 12.8% among lower HIE use dyads (n=32,929, p=0.102). For adults transitioning from hospitals to HHAs among high HIE use dyads, a trend toward lower 30-day readmission rates was identified.

Disaster Preparedness for Vulnerable Persons Receiving In-Home, Long-Term Care in South Carolina

2008 ◽  
Vol 23 (2) ◽  
pp. 133-142 ◽  
Author(s):  
Sarah B. Laditka ◽  
James N. Laditka ◽  
Carol B. Cornman ◽  
Courtney B. Davis ◽  
Maggi J. Chandlee
Keyword(s):  
Health Care ◽  
South Carolina ◽  
Home Health Care ◽  
Disaster Planning ◽  
Home Health ◽  
Personal Care ◽  
Term Care ◽  
Care Services ◽  
Health Agencies ◽  
Home Health Agencies

AbstractPurpose:The purpose of this study was to examine how agencies in South Carolina that provide in-home health care and personal care services help older and/or disabled clients to prepare for disasters.The study also examines how agencies safeguard clients' records, train staff, and how they could improve their preparedness.Methods:The relevant research and practice literature was reviewed. Nine public officials responsible for preparedness for in-home health care and personal care services in South Carolina were interviewed. A telephone survey instrument was developed that was based on these interviews and the literature review. Administrators from 16 agencies that provide in-home personal care to 2,147 clients, and five agencies that provide in-home health care to 2,180 clients, were interviewed. Grounded theory analysis identified major themes in the resulting qualitative data; thematic analysis organized the content.Results:Federal regulations require preparedness for agencies providing inhome health care (“home health”). No analogous regulations were found for in-home personal care. The degree of preparedness varied substantially among personal care agencies. Most personal care agencies were categorized as “less” prepared or “moderately” prepared. The findings for agencies in both categories generally suggest lack of preparedness in: (1) identifying clients at high risk and assisting them in planning; (2) providing written materials and/or recommendations; (3) protecting records; (4) educating staff and clients; and (5) coordinating disaster planning and response across agencies. Home health agencies were better prepared than were personal care agencies.However, some home health administrators commented that they were unsure how well their plans would work during a disaster, given a lack of training. The majority of home health agency administrators spoke of a need for better coordination and/or more preparedness training.Conclusions:Agencies providing personal care and home health services would benefit from developing stronger linkages with their local preparedness systems. The findings support incorporating disaster planning in the certification requirements for home health agencies, and developing additional educational resources for administrators and staff of personal care agencies and their clients.

Increasing Home Health Face-to-Face Certification: Impact of a Hospital-Based Intervention

2018 ◽  
Vol 30 (3) ◽  
pp. 110-115
Author(s):  
Kimberly Pelland ◽  
Emily Cooper ◽  
Alyssa DaCunha ◽  
Kathleen Calandra ◽  
Rebekah Gardner
Keyword(s):  
Chart Review ◽  
Retrospective Chart Review ◽  
Home Health ◽  
Hospitalized Patients ◽  
Post Intervention ◽  
Face To Face ◽  
Hospital Physicians ◽  
Health Agencies ◽  
Community Physician ◽  
Home Health Agencies

Medicare requires that home health patients have a face-to-face visit with a physician when services are initiated and that physicians provide certification of this encounter before home health agencies (HHAs) can be reimbursed. We assessed an intervention to increase completion of face-to-face certification by hospital physicians at discharge using a retrospective chart review. We found a shift in the source and timeliness of certification among intervention hospitals. Pre-intervention, hospital physicians completed face-to-face certifications for 18.7% of patients and community physicians completed certifications for 47.2% ( p < .001), compared with 44.4% and 24.3% ( p < .001) post-intervention. Shifting the source of certification from community to hospital physicians helped HHAs by reducing the burden of tracking down certification from community physician offices and facilitating timely care for recently hospitalized patients.

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