Medicare Beneficiary Outcomes in Rural and Urban Home Health Agencies
The home health prospective payment system (PPS) resulted in major changes in patterns of utilization of home care services. There is some evidence to suggest that some of the post-PPS changes in utilization could compromise quality of care. To date there is little empirical information to assess the quality of home care services and how it varies by rural and urban location. This study is designed to compare the performance of rural and urban home care agencies and to identify the agency characteristics that contribute to better patient care outcomes. Of particular interest, this study will ascertain whether the availability of and pattern of utilization of skilled and ancillary services following implementation of the home health agency PPS is related to performance.
This study will address the following research questions:
- Do rural and urban home health agencies differ in the quality of home care provided?
- To what extent are the following agency characteristics associated with better or worse outcomes?
- To what extent do differences in staff composition, caseload and service intensity contribute to differences in patient outcomes?
Data for this study will be obtained from the Medicare Providers of Services file and the Medicare Home Health Compare (HHC) database. Results will provide preliminary data that may be used in the on-going monitoring of Medicare home care policies on rural communities. Results will be disseminated through a final report and a policy brief.
Publications
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Performance of Rural and Urban Home Health Agencies in Improving Patient Outcomes
Author(s): Janet P. Sutton
Date: 05 / 2006
This study was conducted to determine whether rural and urban home care agencies differ in terms of patient care outcomes, and to ascertain whether there are agency characteristics that are associated with better or worse outcomes. This study found rather small differences in the quality of care provided by home health agencies in rural and urban areas. Findings from the multivariate analyses indicated that rural agencies performed better on measures of improvement in walking, transferring, and dressing, whereas urban agencies performed better on measures of improvement in pain frequency and medication management. Rural or urban location had only a modest effect on functional performance scores. Rural and urban agency differences in rates of unplanned urgent care and hospital admissions were not statistically significant after controlling for other agency characteristics, region of country and characteristics of the health care market.
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