Development and Testing of Health Equity Measures in Home Health Care for Medicare Beneficiaries
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PROJECT SUMMARY Home health care is an essential healthcare service and benefit under the Medicare insurance programs, aimed to improve health outcomes, reduce avoidable hospitalizations, and decrease institutional placements. Racial and ethnic minority Medicare beneficiaries utilize home health care at higher-rates compared to the general Medicare population. Despite the growth and increased use of home health in recent years, there is little evidence about the role of home health agency organizational structures in home health quality and equity. There is also a gap in knowledge about minority-serving home health agencies. Most “high-minority” agencies are rated as lower quality by CMS; however, they may also provide culturally and linguistically appropriate care that should be associated with the best outcomes and highest quality of care. This paradox will be explored using a strengths-based approach, to understand factors associated with high-quality home health care outcomes for racial- and ethnic minority patients overall, and within the context of minority-serving home health agencies. The overall objective of the proposed project is to create home health process and outcome equity measures by calculating race- and ethnicity-specific quality ratings to examine the organizational characteristics of home health agencies with the highest ratings and those with the highest share of patients of color. The evidence generated from this project will be an important first step in (1) creating better measures of health equity that center marginalized populations, and (2) designing and evaluating health systems and policy interventions with the goal of eliminating inequities in essential home health services. Informed by Donabedian’s Structure-Process-Outcomes framework, race- and ethnicity-specific home health quality ratings will be calculated for the process of care and outcome measures used in the Centers for Medicare and Medicaid Services (CMS) star ratings. This study will match, merge, and link national Medicare beneficiaries’ administrative, home health care assessment, and inpatient claims data with home health agency level CMS Care Compare data to evaluate within-home health agency racial inequities in care quality outcomes through two aims: (1) Compose and demonstrate the utility of race and ethnic group-specific home health agency quality ratings, adapting the methodology used by CMS Care Compare. We will evaluate utility of the new race- and ethnicity-specific measures in comparison to the original, overall measures through the calculation of reliability and informativeness metrics. (2) Assess home health agency structure as a predictor of quality and equity in home health agency process and outcomes. Home health agency structural factors (e.g., minority-serving, size, tenure, ownership, rurality) will be used to predict race- and ethnicity-specific care quality process (i.e., timely initiation of care) and outcome measures (e.g., functional improvements, hospitalizations). This work is both timely and significant, with the potential to profoundly impact quality and health equity measurement within home health and other healthcare sectors.
