Home Health Care Diagnostic Severity: The disparity of rural minorities
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.
Learning Areas:Chronic disease management and prevention
Diversity and culture
Provision of health care to the public
Describe differences in diagnostic severity between rural minority and urban residents.
Keyword(s): Rural Health, Aging
Qualified on the content I am responsible for because: I have conducted health services research as a research associate at the SC Rural Health Research Center for over 5 years. I have participated in several studies funded by the federal Office of Rural Health Policy.
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.