Measuring racial and ethnic disparities in the functional status of Medicare home health care patients

Communities of color continue to experience differences in access, treatment, and quality of care in Medicare even after accounting for differences in age, education, and income. With increased emphasis on providing care in the least restrictive and most cost-effective manner, the demand for home health care is increasing. Thus, it is crucial to understand the interactions at play in this unique health care setting. Some studies have shown that access disparities exist in home health and others have demonstrated differences in outcomes by race/ethnicity. However, study limits prevent us from declaring these differences to be indicative of a disparity. Understanding racial/ethnic disparities in the home health system is essential for advancing the overall health of the Medicare population, and reducing costs from morbidity and mortality. Utilizing existing data from the Outcome ASsessment Information Set, and Provider of Services file for all home health assessments conducted in 2006, we tested the hypothesis that minority home care patients would have lower functional status at discharge compared to white patients. Multivariate regression procedures on composite measures of activities of daily living and instrumental activities of daily living employing rasch modeling, demonstrated that minority home health recipients experienced greater deterioration in functional status during their home health episode relative to white patients. These results were significant for all groups except Native Hawaiian/Pacific Islanders. We discuss key strategies for modeling these trends including the use of rasch models vs. likert measures, and procedures to account for clustering within agencies and neighborhoods.