Home Health Care Diagnostic Severity: The disparity of rural minorities

purpose:  Among home health (HH) patients, clinical severity is inversely linked to HH provider profit margins.  This can lead to “cherry-picking” among providers. In rural areas, where few providers are present, high severity can lead to financial distress or withdrawal from the market, reducing the availability of care.

methods: Data were drawn from the 2010 Outcome Assessment Information Set, which records a provider-conducted clinical evaluation of patient status.  Analysis was restricted to start of care assessments, excluding those with missing data on key variables (n = 982,794). Rurality was measured using the 2003 Urban Influence Codes. The main independent variables were rurality and race. The outcome variable was high diagnostic severity defined as symptoms poorly controlled with/without history of rehospitalization. Adjusted analysis controlled for sex, age, insurance, living arrangements, and assessor discipline (RN versus other).

results: The majority of beneficiaries (57.7%) were rated as high diagnostic severity. Severity was higher for African American rural residents (61.7% high) than for African American urban residents (56.5% high) and White urban residents (56.5% high). Adjusted analysis demonstrated an interaction between race and rurality. Rural residents of each race had greater odds for high diagnostic severity when compared to assessments for White urban residents.

conclusion: This study corroborates previous findings of race and residence-based disparities. Future policy decisions that impact rural home health agency profit margins must account for the needs and clinical severity of the patient population served.