Potentially More Out of Reach: Public Reporting Exacerbates Inequities in Home Health Access

Abstract

r Public reporting is associated with both mitigating and exacerbating inequities in high-quality home health agency use for marginalized groups.r Ensuring equitable access to home health requires taking a closer look at potentially inequitable policies to ensure that these policies are not inadvertently exacerbating disparities as home health public reporting potentially does.r Targeted federal, state, and local interventions should focus on raising awareness about the five-star quality ratings among marginalized populations for whom inequities have been exacerbated.

Getting to the root: Examining within and between home health agency inequities in functional improvement

“…Mitigating the inequities described here requires that we acknowledge how differently these inequities are created across groups. Rarely are inequities eliminated with a broad approach to quality improvement; in fact, broad quality improvement may exacerbate disparities, and targeted approaches are needed 11,40,46,59 …”

“…The overall disparities in functional improvement may be inequities caused by racism and income-based discrimination. 22 The overall inequities driven by between-HHA differences may in part reflect structural racism and discrimination in access to higher quality HHAs for patients, 10,11,23 while the within-HHA disparities may reflect differences in how patients are treated by the HHA or interpersonal racism and discrimination within HHAs. 24 Our study provides insight into why the literature may be mixed concerning racial disparities in functional improvement.…”

“…Rarely are inequities eliminated with a broad approach to quality improvement; in fact, broad quality improvement may exacerbate disparities, and targeted approaches are needed. 11,40,46,59 ACKNOWLEDGMENTS This work was supported by the National Institute on Aging (1R36-AG068199). Authors Shekinah A. Fashaw-Walters, Gilbert Gee, Olga F. Jarrín, Manka Nkimbeng, and Kali S. Thomas have no potential conflicts of interest to declare.…”

“…While the previous two studies document within-HHA disparities, as it relates to between-HHA disparities, prior research suggests that there are racial, ethnic, and income inequities in receiving care from high-quality HHAs. 10,11 In addition, various HHA characteristics such as agency racial and Medicaid-patient composition, ownership, size, staffing, and rurality have been shown to be associated with quality differences between HHAs. 8,[12][13][14][15][16][17] Given this research, it is important to understand how disparities in outcomes may be a function of differences in agencies from whom older patients receive their care.…”

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

“…Prior literature has mostly focused on the immediate effect of the introduction of star ratings and how they might be used by consumers to select care, finding small increases in the probability of selecting a high-quality HHA . These studies often examine each star rating separately, with most focused on the quality of patient care rating . Other work has examined factors contributing to variation in access and use of high-quality HHAs, finding that Black and Hispanic as well as lower-income HHA users have lower probabilities of high-quality HHA use compared with their White or higher income neighbors .…”