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Potentially More Out of Reach: Public Reporting Exacerbates Inequities in Home Health Access.

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Title: Potentially More Out of Reach: Public Reporting Exacerbates Inequities in Home Health Access.
Authors: FASHAW‐WALTERS, SHEKINAH A., RAHMAN, MOMOTAZUR, GEE, GILBERT, MOR, VINCENT, RIVERA‐HERNANDEZ, MARICRUZ, FORD, CERON, THOMAS, KALI S.
Source: Milbank Quarterly. Jun2023, Vol. 101 Issue 2, p527-559. 33p. 2 Charts, 3 Graphs.
Subjects: Medical quality control, Health policy, Racism, Native Americans, Research, Health services accessibility, Scientific observation, Confidence intervals, Home care services, Economic status, Black people, Hispanic Americans, Alaska Natives, Race, Population geography, Health outcome assessment, Income, Pre-tests & post-tests, Centers for Medicare & Medicaid Services (U.S.), Value-based healthcare, Public health records, Research funding, Quality assurance, Independent living, Descriptive statistics, Health equity, Poverty, Sensitivity & specificity (Statistics), Medical informatics, Public opinion, Longitudinal method, Medicare
Abstract: Policy PointsPublic reporting is associated with both mitigating and exacerbating inequities in high‐quality home health agency use for marginalized groups.Ensuring equitable access to home health requires taking a closer look at potentially inequitable policies to ensure that these policies are not inadvertently exacerbating disparities as home health public reporting potentially does.Targeted federal, state, and local interventions should focus on raising awareness about the five‐star quality ratings among marginalized populations for whom inequities have been exacerbated. Context: Literature suggests that public reporting of quality may have the unintended consequence of exacerbating disparities in access to high‐quality, long‐term care for older adults. The objective of this study is to evaluate the impact of the home health five‐star ratings on changes in high‐quality home health agency use by race, ethnicity, income status, and place‐based factors. Methods: We use data from the Outcome and Assessment Information Set, Medicare Enrollment Files, Care Compare, and American Community Survey to estimate differential access to high‐quality home health agencies between July 2014 and June 2017. To estimate the impact of the home health five‐star rating introduction on the use of high‐quality home health agencies, we use a longitudinal observational pretest–posttest design. Findings: After the introduction of the home health five‐star ratings in 2016, we found that adjusted rates of high‐quality home health agency use increased for all home health patients, except for Hispanic/Latine and Asian American/Pacific Islander patients. Additionally, we found that the disparity in high‐quality home health agency use between low‐income and higher‐income home health patients was exacerbated after the introduction of the five‐star quality ratings. We also observed that patients within predominantly Hispanic/Latine neighborhoods had a significant decrease in their use of high‐quality home health agencies, whereas patients in predominantly White and integrated neighborhoods had a significant increase in high‐quality home health agency use. Other neighborhoods experience a nonsignificant change in high‐quality home health agency use. Conclusions: Policymakers should be aware of the potential unintended consequences for implementing home health public reporting, specifically for Hispanic/Latine, Asian American/Pacific Islander, and low‐income home health patients, as well as patients residing in predominantly Hispanic/Latine neighborhoods. Targeted interventions should focus on raising awareness around the five‐star ratings. [ABSTRACT FROM AUTHOR]
Copyright of Milbank Quarterly is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Policy PointsPublic reporting is associated with both mitigating and exacerbating inequities in high‐quality home health agency use for marginalized groups.Ensuring equitable access to home health requires taking a closer look at potentially inequitable policies to ensure that these policies are not inadvertently exacerbating disparities as home health public reporting potentially does.Targeted federal, state, and local interventions should focus on raising awareness about the five‐star quality ratings among marginalized populations for whom inequities have been exacerbated. Context: Literature suggests that public reporting of quality may have the unintended consequence of exacerbating disparities in access to high‐quality, long‐term care for older adults. The objective of this study is to evaluate the impact of the home health five‐star ratings on changes in high‐quality home health agency use by race, ethnicity, income status, and place‐based factors. Methods: We use data from the Outcome and Assessment Information Set, Medicare Enrollment Files, Care Compare, and American Community Survey to estimate differential access to high‐quality home health agencies between July 2014 and June 2017. To estimate the impact of the home health five‐star rating introduction on the use of high‐quality home health agencies, we use a longitudinal observational pretest–posttest design. Findings: After the introduction of the home health five‐star ratings in 2016, we found that adjusted rates of high‐quality home health agency use increased for all home health patients, except for Hispanic/Latine and Asian American/Pacific Islander patients. Additionally, we found that the disparity in high‐quality home health agency use between low‐income and higher‐income home health patients was exacerbated after the introduction of the five‐star quality ratings. We also observed that patients within predominantly Hispanic/Latine neighborhoods had a significant decrease in their use of high‐quality home health agencies, whereas patients in predominantly White and integrated neighborhoods had a significant increase in high‐quality home health agency use. Other neighborhoods experience a nonsignificant change in high‐quality home health agency use. Conclusions: Policymakers should be aware of the potential unintended consequences for implementing home health public reporting, specifically for Hispanic/Latine, Asian American/Pacific Islander, and low‐income home health patients, as well as patients residing in predominantly Hispanic/Latine neighborhoods. Targeted interventions should focus on raising awareness around the five‐star ratings. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Milbank Quarterly is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/1468-0009.12616
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        Text: English
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      – SubjectFull: Medical quality control
        Type: general
      – SubjectFull: Health policy
        Type: general
      – SubjectFull: Racism
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      – SubjectFull: Medicare
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      – TitleFull: Potentially More Out of Reach: Public Reporting Exacerbates Inequities in Home Health Access.
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