Online Program

Home Health Care Diagnostic Severity: The disparity of rural minorities

Monday, November 2, 2015

Grishma Bhavsar, PhD, MPH, Department of Health Sciences, California State University, Northridge, Northridge, CA
Janice C. Probst, PhD, University of South Carolina, South Carolina Rural Health Research Center, Columbia, SC
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.

Learning Areas:

Chronic disease management and prevention
Diversity and culture
Provision of health care to the public

Learning Objectives:
Describe differences in diagnostic severity between rural minority and urban residents.

Keyword(s): Rural Health, Aging

Presenting author's disclosure statement:

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.