Poor and Racial Minorities Have Worse Home Health Care Outcomes

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Karen Joynt Maddox, MD, MPH Washington University School of Medicine Saint Louis MO

Dr. Joynt-Maddox

Karen Joynt Maddox, MD, MPH
Washington University School of Medicine
Saint Louis MO

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Home health is one of the fastest-growing sectors in Medicare, and the setting of a new federal value-based payment program, yet little is known about disparities in clinical outcomes among Medicare beneficiaries receiving home health care.

We found that beneficiaries who were poor or Black had worse clinical outcomes in home health care than their peers. These individuals were generally more likely to have unplanned hospitalizations, readmissions, and emergency department visits. Under Home Health Value-Based Purchasing, these patterns should be tracked carefully to ensure the program helps close the gaps rather than widening them.

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Better Coordination Needed Between Hospital Physicians and Home Health Care Providers

MedicalResearch.com Interview with:

Christine D. Jones, MD, MS, Assistant professor Director of Care Transitions, Hospital Medicine Group University of Colorado School of Medicine

Dr. Jones

Christine D. Jones, MD, MS
Assistant professor
Director of Care Transitions, Hospital Medicine Group
University of Colorado School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for this study is that referrals to home health care at hospital discharge have increased over recent years.  Yet, care coordination including information exchange and communication is often suboptimal between the hospital and home health care and may contribute to medication list discrepancies and even hospital readmissions.

We spoke with focus groups of home health nurses and our main findings were that improvements in key areas could care coordination after hospital discharge.

Specific solutions included:

1) Clearly defining the accountability for home health orders after discharge between hospitalists and primary care providers

2) Changes to insurance requirements that currently only allow physicians to write home health orders so that nurse practitioners and physician assistants can also write home health orders

3) Enhancing access for home health agencies to hospital electronic health records and direct phone lines

4) Encouraging liaisons from home health agencies to meet patients in the hospital to align clinician and patient expectations

5) Direct coordination between home health nurses and clinicians or pharmacists to resolve medication discrepancies

6) Ensuring that detailed information about cognitive and behavioral health is included in information provided to home health from referring hospitals

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Home Health Care Providers Increase, But Geographic Variability Persists

MedicalResearch.com Interview with:
Sheila Eckenrode RN, CPHQ
Quality Improvement Consultant
The New England QIN-QIO
Qualidigm, Wethersfield, Connecticut

MedicalResearch.com: What is the background for this study?

Response: Post-acute care has become a focus for improving quality and cost effectiveness of healthcare in the United States. Changes in Medicare payment systems such as bundled payments and the emergence of Affordable Healthcare Organizations will most likely lead to expansion of post-acute care services and decrease in  acute care hospitalizations. Approximately  30% of hospitalized Medicare beneficiaries were referred to home health care at discharge in 2012.  In 2013, home health agencies served  3.5 million beneficiaries with Medicare paying  $18 billion for these services. Home health care has been emphasized under the Improving Medicare Post-Acute Care Transformation Act of 2014 to provide and improve care at individual patient and community levels. In anticipation of increasing utilization of home care services, our study aimed to demonstrate the overall growth in home care availability as well as identify geographical variation and potential gaps in service.

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