Racial/Ethnic Disparities in Home Health Care: Charting a Course for Future Research

Abstract

Racial/ethnic disparities in health have been well-documented. However, we know little about the existence of or mechanisms that contribute to disparities in home health care. This article proposes a conceptual framework, based on a comprehensive review of the literature, to guide research to understand whether and how disparities emerge in home health care. The framework outlines the patient, agency, practice, and system factors that have been shown to or theoretically could contribute to disparities. Enhanced parity in home health care will impact society by reducing health costs due to morbidity, while directly benefiting minority patients.

Systematic Review of Racial/Ethnic Outcome Disparities in Home Health Care

“…Most efforts to alleviate racial and ethnic disparities seem to have taken place in primary and acute care settings (Davitt, 2014), leaving knowledge about the prevalence, impact, and prevention of disparities in home health care still in its infancy (Davitt, 2012). For example, there is little evidence that home health care agencies either individually or as an industry have incorporated the CLAS Standards into their practices (Narayan, 2002(Narayan, , 2017.…”

Racial and Ethnic Disparities in Patients’ Experience With Skilled Home Health Care Services

“…Whether these differences are substantively important, and whether they are attributable to cultural norms or to differences in quality of care received by patients is not clear. Second, whether differences in ratings of experience of care by race/ethnicity are a result of true disparities in the quality of care received (i.e., arising from underlying inequality; Davitt, 2012), or alternatively, attributable to differences in patient expectations of care or differences in use of rating scale values, can be difficult to disentangle. This is an important study that provides heretofore unknown data about patients receiving home health care.…”

Funding a Health Disparities Research Agenda: The Case of Medicare Home Health Care

“…In moderation, the effect of the predictor (race/ethnicity) on the criterion variable (adverse events or health status) will vary according to a third variable such as gender (Holmbeck, 1997). For a more detailed description of mediator and moderator variables, see Davitt, 2012. This mixed methods study combined secondary analysis of Medicare administrative data from the Outcome Assessment and Information Set (OASIS) and Provider of Service (POS) data files with qualitative focus group interviews of home health agency staff. We had the entire population of home health users for the year 2006, which amounted to 2,844,129 unduplicated home health users.…”

“…The terms disparity and inequity as used in this manuscript refer to a difference in health care or health status that is due to an underlying inequality, rather than the result of individual preference, biobehavioral factors (e.g., smoking), or selection bias (e.g., illness severity) (Davitt, 2012;Kilbourne, Switzer, Hyman, Crowley-Matoka, & Fine, 2006;Smedley, Stith, & Nelson, 2003). LaVeist (2004) proposes two key domains of health disparities.…”