NEIGHBORHOOD CHARACTERISTICS AND QUALITY PERFORMANCE OF HOME HEALTH AGENCIES: A COHORT STUDY

Abstract

Abstract Home health care (HHC) is a core source of home- and community-based services to older adults “aging in place’. This study examined variation in HHC quality by neighborhood characteristics in the US by using 5 years (2014-2019) of national Home Health Compare data linked to Providers of Services (POS) files and Area Health Resources Files (AHRF). HHC quality was measured by agency rates of timely initiation of care, hospitalization, and ED visits. We examined 7,487 HHC agencies (37,435 agency-years) in 1,760 counties. At baseline, the mean rates of timely initiation of care, hospitalization, and ED visit were 91.5%, 15.8%, and 12.5%. On average, county percentage of Blacks, Hispanic, individuals with college degree, unemployment, and being in poverty were 12.9% (range: 0.1% – 76.0%), 20.6% (0.4% - 95.8%), 30.4% (7.3% - 77.6%), 5.4% (2.1% - 24.0%), and 14.4% (3.1% - 38.0%) respectively in 2015. Estimates from multivariate regressions showed that neighborhoods with higher proportion of Blacks (β= -0.04, p=0.000) and Hispanics (β= -0.02, p=0.000), higher rate of unemployment (β= -0.07, p=0.035) were less likely to have HHC agencies providing timely initiated care; neighborhoods with higher proportions of Blacks (β= 0.01, p=0.000) and higher poverty rates (β= 0.02, p=0.027) were more likely to have HHC agencies with higher hospitalization rates; and neighborhoods with higher poverty rates (β= 0.04, p=0.000) were more likely to have HHC agencies with higher ED visit rates. Our findings indicate that racial/ethnic minorities in neighborhoods with low socioeconomic status were less highly to access high quality HHC.