OBJECTIVES To evaluate home health agency quality performance. DESIGN Observational study. SETTING Home health agencies PARTICIPANTS All Medicare-certified agencies with at least 6 months of data from 2011 to 2015. MEASUREMENTS Twenty-two quality indicators, five patient survey indicators, and their composite scores. RESULTS The study included 11,462 Medicare-certified home health agencies that served 92.4% of all ZIP codes nationwide, accounting for 315.2 million people. The mean composite scores were 409.1 ± 22.7 out of 500 with the patient survey indicators and 492.3 ± 21.7 out of 600 without the patient survey indicators. Home health agency performance on 27 quality indicators varied, with the coefficients of dispersion ranging from 4.9 to 62.8. Categorization of agencies into performance quartiles revealed that 3,179 (27.7%) were in the low-performing group (below 25th percentile) at least one time during the period from 2011–12 to 2014–15 and that 493 were in the low-performing group throughout the study period. Geographic variation in agency performance was observed. Agencies with longer Medicare-certified years were more likely to have high-performing scores; agencies providing partial services, with proprietary ownership, and those with long travel distances to reach patients had lower performance. Agencies serving low-income counties and counties with lower proportions of women and senior residences and greater proportions of Hispanic residents were more likely to attain lower performance scores. CONCLUSION Home health agency performance on several quality indicators varied, and many agencies were persistently in the lowest quartile of performance. Still, there is a need to improve the quality of care of all agencies. Many parts of the United States, particularly lower-income areas and areas with more Hispanic residents, are more likely to receive lower quality home health care.
The presence of Arsenic, in drinking water, is a growing problem all around the world. The situation, in many developing countries, including Pakistan, has become quite alarming. Development of a low-cost treatment method for the removal of arsenic is desired. Recently, iron nails were found useful in removing arsenic in slow sand filters. It is referred as Kanchan Arsenic Filter (KAF). This study aimed to further build upon the above stated research work on KAF. Three different form of iron: (1) iron slag; (2) nails; and (3) mesh were tested. The raw water contained 100 ppb of arsenic. Equal weight of 1 kg for three iron forms was used. Rate of filtration was 30 L/hr. at the start which decreased to around 20 L/hr. after eight weeks. Removal efficiency of mesh, nails and slag was 99.90%, 98.94% and 98.01% respectively at 8 th week and 224 L of water treated. The effluent concentration of arsenic was 1.99, 1.06 and 0.099 ppb for iron slag, nails and mesh, respectively. It can be concluded from above results that among different shapes of iron used, mesh was the most efficient form of iron. Percentage removal of turbidity for mesh, nails and slag at the end of the filter run was 88%, 86% and 88% respectively. Removal of chlorides for mesh, nails and slag after eight weeks was 65%, 70% and 73%. pH change of water after eight week of filter run was negligible. Hardness removal for all three filters was ranging from 16 to 28%. The newly developed filter is referred as Pakistan Arsenic Filter (PAF).
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