Disparities in Home Healthcare Outcomes: Exploring Practice Factors

Disparities in health outcomes are well documented in the literature. Recent studies point to disparate outcomes for minority recipients of home healthcare as well. There is a critical lack of understanding regarding the role that practice factors play in home health disparities. To fill this gap we turned to non-physician professionals and paraprofessionals who are on the front line of home healthcare. This work explores their unique and intimate perspectives on caring for the elderly in their homes and explores the complex, often unarticulated, practice factors that may contribute to disparate health outcomes. Results from 4 focus groups with staff from a variety of home healthcare agency models located in a diverse metropolitan area will be presented. We report qualitative findings that highlight themes such as provider discretion, agency policies/procedures, communication barriers, bias and prejudice that inform our understanding of the dynamics at play in the context of home healthcare. We compare and contrast the perspectives of professionals and paraprofessionals in order to explore the multidimensional nature of home healthcare. Staff perceptions of the practice factors that influence the relationship between home health outcomes and race/ethnicity will be discussed, including: challenges in providing home healthcare; staff diversity; staff-patient cultural, racial and ethnic barriers; institutional racism, individual bias/stereotyping; and physical, geographic and logistic barriers to consistent quality care. Ultimately, the goal of this research is to alleviate disparities and improve health outcomes by enhancing our understanding of practice factors.