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

Wang, Jinjiao; Ying, Meiling; Li, Yue

doi:10.1177/07334648211053859

Cited by 4 publications

(4 citation statements)

References 44 publications

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“…Though we mainly focused on overall trends, there were some differences in the observed levels of the outcomes, with Black, dual-eligible, and ADRD patients associated with higher levels of hospitalizations, lower timely initiation, and less functional improvement, regardless of receiving care from a high-quality agency. This aligned with prior work establishing that socially higher-risk patients are less likely to report high experience of care ratings 20 and are more likely to experience adverse clinical outcomes. 21 …”

Section: Discussionsupporting

confidence: 77%

“…Claims-Based vs Agency-Reported Patient Outcomes Among Home Health Agencies higher-risk patients are less likely to report high experience of care ratings 20 and are more likely to experience adverse clinical outcomes. 21 The similarity in trends between high quality of patient care and high quality patient satisfaction HHAs may be surprising given prior literature, which identified a weak correlation between these 2 ratings.…”

Section: Jama Network Open | Geriatricsmentioning

confidence: 99%

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Claims-Based vs Agency-Reported Patient Outcomes Among Home Health Agencies, 2013-2019

Chen,

Fu,

Grabowski

2024

JAMA Netw Open

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ImportanceGiven the growth of home health agency (HHA) care, it is important to understand whether quality reporting programs, such as star ratings, are associated with improved patient outcomes.ObjectiveTo assess the immediate and long-term association of the introduction of HHA star ratings with patient-level quality outcomes, comparing claims-based and agency-reported measures.Design, Setting, and ParticipantsThis cross-sectional study used Medicare HHA claims and agency-reported assessments to identify sequential patient episodes (ie, spells) among US adults with traditional Medicare who received HHA care (2013-2019). An interrupted time series (ITS) model was used to measure changes in trends and levels before and after the introduction of star ratings. Statistical analysis was performed from November 2022 to September 2023.ExposureThe exposure was the introduction of HHA star ratings. The postexposure period was set as starting January 1, 2016, to account for the period when both star ratings (quality of patient care and patient satisfaction rating) were publicly reported.Main Outcomes and MeasuresThe main outcomes included claims-based hospitalization measures (both during the patient spell and 30 days after HHA discharge) and agency-reported functional measures, such as improvement in ambulation, bathing, and bed transferring. There was also a measure to capture timely initiation of care among post–acute care HHA users, defined as HHA care initiated within 2 days of inpatient discharge.ResultsThis study identified 22 958 847 patient spells to compare annual changes over time; 9 750 689 patient spells were included during the pre–star ratings period from January 1, 2013, to December 31, 2015 (6 067 113 [62.2%] female; 1 100 145 [11.3%] Black, 512 487 [5.3%] Hispanic, 7 845 197 [80.5%] White; 2 656 124 [27.2%] dual eligible; mean [SD] patient spell duration, 70.9 [124.9] days; mean [SD] age, 77.4 [12.0] years); 13 208 158 patient spells were included during the post–star ratings period from January 1, 2016, to December 31, 2019 (8 104 69 [61.4%] female; 1 385 180 [10.5%] Black, 675 536 [5.1%] Hispanic, 10 664 239 [80.7%] White; 3 318 113 [25.1%] dual eligible; mean [SD] patient spell duration, 65.3 [96.2] days; mean [SD] age, 77.7 [11.6] years). Results from the ITS models found that the introduction of star ratings was associated with an acceleration in the mean [SE] hospitalization rate during the spell (0.39% [0.05%] per year) alongside functional improvements in ambulation (2.40% [0.29%] per year), bed transferring (3.95% [0.48%] per year) and bathing (2.34% [0.19%] per year) (P &lt; .001). This occurred alongside a 1.21% (0.12%) per year reduction in timely initiation of care (P &lt; .001).Conclusions and RelevanceThis cross-sectional study found an observed improvement in agency-reported functional measures, which contrasted with slower increases in more objective measures such as hospitalization rates and declines in timely initiation of care. These findings suggest a complex picture of HHA quality of care after the introduction of star ratings.

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Section: Discussionsupporting

confidence: 77%

Section: Jama Network Open | Geriatricsmentioning

confidence: 99%

Claims-Based vs Agency-Reported Patient Outcomes Among Home Health Agencies, 2013-2019

Chen,

Fu,

Grabowski

2024

JAMA Netw Open

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“…Moreover, adequate access does not mean just the initial HaH stay. Access to high‐quality post‐acute care in disadvantaged areas and those areas with predominantly minoritized populations is reduced 11 . Thus to achieve equity, bundling the acute care phase with high‐quality post‐acute transitional stay including rehabilitative, nursing, social work, and medical services is needed.…”

Section: Ensuring Adequate Access To Hahmentioning

confidence: 99%

What's next for Hospital at Home Programs in the United States: A clarion call for permanent, person‐centered solutions

Brody

Dorfman

Caspers

et al. 2022

J American Geriatrics Society

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Even with high-quality care, the hospital can be a dangerous place for older adults. Iatrogenesis, including delirium, infection, and loss of function are widespread and can have long-lasting effects that extend far beyond the initial hospitalization. 1,2 Moreover when thinking through the lens of person-centered care (PCC), few things in the hospital center around patient and family wishes; for instance, being tethered to intravenous lines and instructed not to ambulate without help; vital signs and medications scheduled at late hours preventing healthy sleep and recovery from illness; wearing dehumanizing hospital gowns; and limiting of visitors, all in an unfamiliar, institutional environment.This editorial comments on the article by Gorbenko et al. in this issue.

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“…For HHAs, the enactment of CON laws mainly limits the entry of new agencies into the market (American Health Planning, 2021; National Academy for State Health Policy, 2021, National Conference of State Legislatures, 2021). There is limited evidence on how state CON laws might influence the availability and performance of HHAs and more studies are needed to evaluate access of home health services (Atemnkeng, 2020; Conover & Bailey, 2020; Ohsfeldt & Li, 2018; Probst et al, 2014; Wang et al, 2022). In response to these concerns, this study aims to examine the association of CON laws with HHAs' service availability and utilization in the United States (US).…”

Section: Introductionmentioning

confidence: 99%

Association Between States’ Certificate of Need Laws and Home Health Care Access in the US

Nataliansyah,

Ward,

Zhu

2023

J Appl Gerontol

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Home health care has a significant role in the care of Medicare beneficiaries. Certificate of Need (CON) laws for home health agencies limit their number in affected states. This study’s objective was to evaluate the association of CON laws with the availability and service utilization of urban and rural home health agencies in CON states and non-CON states using the generalized estimating equations (GEE) method. The results from this study indicated that CON states have fewer home health agencies for their Medicare population than non-CON states, regardless of urbanicity or rurality. Home health agencies in CON states also have less service utilization in terms of care episodes and visits per patient. This study provides an understanding of the effects of CON laws on Medicare beneficiaries' home health access and experiences.

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

Cited by 4 publications

References 44 publications

Claims-Based vs Agency-Reported Patient Outcomes Among Home Health Agencies, 2013-2019

Claims-Based vs Agency-Reported Patient Outcomes Among Home Health Agencies, 2013-2019

What's next for Hospital at Home Programs in the United States: A clarion call for permanent, person‐centered solutions

Association Between States’ Certificate of Need Laws and Home Health Care Access in the US

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