Understanding racial/ethnic disparities in home health outcomes: The clinical practice factors

Recent studies provide some initial, yet inconclusive, evidence of differential outcomes in Medicare home health for minorities. Limits in this research prevent us from determining whether and to what extent race/ethnicity is a critical determinant of home health outcomes. None of the existing studies have explained the full range of factors or how they contribute to the relationship between race/ethnicity and home health outcomes. A critical gap is the lack of understanding regarding the role that practice factors play in home health disparities. Home health practice is unique among health care delivery systems; care is provided in the patient's home and by non-physician professionals and paraprofessionals. Additional research is needed to understand the dynamics of care in home health and via non-physician practitioners to understand the practice factors that contribute to racial/ethnic disparities in outcomes. Results from 5 focus groups with 50 Home health agency staff (direct care and managers) in a variety of agency types from a tri-state metropolitan area will be presented. Staff perceptions of the practice factors that influence the relationship between home care outcomes and race/ethnicity, will be discussed, including: current challenges in providing home health; strategies and challenges in providing services to a diverse patient population; staff diversity, staff training, geographic limits, policies, institutional racism, and individual bias/stereotyping. Ultimately, the goal of this research agenda is to alleviate racial/ethnic disparities in home health outcomes, by enhancing our understanding of the patient, agency, practice, and system factors that contribute to racial/ethnic disparities in home health outcomes.