257232 Poorer utilization outcomes of Medicare-certified home health care in areas with high levels of Native American/Alaska Native residents

Monday, October 29, 2012

Samuel Towne, MPH, CPH , Health Services Policy and Management, University of South Carolina; South Carolina Rural Health Research Center, Columbia, SC
Janice C. Probst, PhD , University of South Carolina, South Carolina Rural Health Research Center, Columbia, SC
Jordan Mitchell, MBA , South Carolina Rural Health Research Center, University of South Carolina, Columbia, SC
Zhimin Chen, MS , South Carolina Rural Health Research Center, Columbia, SC
Compared to most other groups, Native Americans/Alaska Natives (NA/AN) individuals have higher levels of chronic disease and morbidity. Many are concentrated in rural areas, which may have lower and poorer levels of service, including home health care (HHC) service. We examined whether quality indicators reported to CMS by Medicare-certified HHC agencies are equal in areas with higher levels of NA/AN residents. We conducted a cross-sectional analysis using Medicare's Home Health Compare files (2008) and RTI International's Spatial Impact Factor Data (v3, 2010). The unit of analysis was the ZCTA (n=32,239). The independent variable was NA/AN concentration, dichotomized into high (at or above the 95th percentile) versus all other. The dependent variables were risk-adjusted patient self-care quality measures. Adjusted analyses controlled for rurality, income, Medicare eligibles and proportion white. Unadjusted means for patients admitted to the hospital were 29.9% (high NA/AN=31.9%; other=29.8%, p<.0001); 23.7% (high NA/AN=24.8%; other=23.7%, p<.0001) for patients needing emergent care; 1.3% (high NA/AN=1.4%; other=1.3%, p=.0002) for those needing emergent care due to a wound getting worse; and 66.2% (high NA/AN=63.5%; other=66.3%, p<.0001) for staying home after an episode of care. In multivariable analysis, areas with high levels of NA/AN residents had higher rates of being admitted to the hospital and needing emergent care; while rates of staying home after an episode of care were lower. Vulnerable individuals receiving HHC in these areas are facing several gaps with regard to quality of care. Further research is needed to identify sources of these disparities and design corrective actions.

Learning Areas:
Chronic disease management and prevention
Diversity and culture
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Public health or related research

Learning Objectives:
At the conclusion of this session, the learner will be able to: Describe gaps in the quality of Medicare-certified Home Health Care across areas with higher levels of Native Americans/Alaska Natives (NA/AN) and Evaluate the need for policy alternatives that seek to eliminate gaps in the quality of care provided in rural and NA/AN areas.

Keywords: Native Americans, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be an abstract author on the content I am responsible for because I have successfully completed a CEPH accredited MPH program, am Certified in Public Health by the National Board of Public Health Examiners and am currently in a public health PhD program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.