Statement of the problem: Rural residents have lower access to home health care services. Rural home health patients have lower health status as compared to their urban counterparts. The lack of available home health care services in more rural and remote areas may lead to higher institutional long term care admissions by rural and remote residents. Rural home health agencies tend to have a greater supply of patients needing assistance with long-term care, which carries a greater cost on average than those with more acute care needs.

Project goals: We will examine current patient case-mix for the Medicare and Medicaid population (18 and older) receiving skilled health care from a home health agency to determine if there are rural or race/ethnicity-based disparities with regards to receipt of services and clinical acuity indicators, including provider type caring for patient.

Methods: We will conduct a cross-sectional analysis to identify differences in patient acuity across rurality with patient acuity measured as prognosis, life expectancy, and variety of Activities of Daily Living (ADLs) and other risk assessments. We will use data from the Home Health Outcome and Assessment Information Set from the Centers for Medicare and Medicaid Services (CMS). We will use Rural Urban Commuting Area Codes (RUCA) from the HRSA Area Resource File to measure rurality. We will conduct descriptive and bivariate analyses to describe rural and race-based disparities.

Anticipated publications or products: A descriptive technical report will be published based on the study findings. Additionally, we will draft manuscripts for publications in peer-reviewed journals, policy briefs for ORHP, and scholarly presentations for disseminating results in local, regional, and national conferences.

Publications

• Differences in Case-Mix Between Rural and Urban Recipients of Home Health Care
  Report
  Rural and Minority Health Research Center
  Date: 10/2014
  This report provides a description of the health status and service needs of rural and urban Medicare home health patients based on professional assessments of their conditions at the start of care.