Research has shown that delayed receipt of home healthcare (HHC) is linked to negative patients' outcomes such as hospitalizations, emergency department visits, and death. Studies have looked at factors contributing to delays including high-unemployment areas and racial/ethnic backgrounds of patients. However, no previous study had examined how the deliverance of timely care differs among levels of neighborhood disadvantage within an urban city. The objective of this study was to assess if there were associations between neighborhood disadvantage and delayed start-of-care (SOC) HHC visits.

Methods

We conducted a retrospective observational study on newly admitted HHC patients after a hospital discharge during the years 2021 and 2022. The total sample included 73,536 HHC episodes of care. We used log-binomial regressions to examine the association between a delayed SOC HHC visit, defined as a first HHC visit occurring after 48 h of hospital discharge, and neighborhood disadvantage, adjusting for patients' age, race, sex, and clinical status.

Results

Close to one-third (23,712; 32.3%) of HHC episodes experienced a delayed SOC HHC visit. As the level of neighborhood disadvantage increased, so did the risk of experiencing delayed care. After adjusting for covariates, patients living in the most disadvantaged neighborhoods (level 5) had a 13% (RR 1.13; 95% CI 1.10–1.17) higher risk of experiencing delayed care when compared to those in the least disadvantaged neighborhoods (level 1). As the level of neighborhood disadvantage increased, so did the proportion of minority patients.

Conclusions

These findings underscore the disparities in receipt of timely HHC among differing levels of neighborhood disadvantage. As HHC is presented as a safer and more comfortable alternative to institutional post-acute care, ensuring the availability and equitable care is essential for maintaining high-quality care especially for already marginalized populations.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting Information

References

1 Medicare and Home Health Care (Centers for Medicare & Medicaid Services, 2003), accessed 2024, https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/HHQIHHBenefits.pdf.
Google Scholar
2J. G. Burgdorf, J. L. Wolff, J. A. Chase, and A. I. Arbaje, “Barriers and Facilitators to Family Caregiver Training During Home Health Care: A Multisite Qualitative Analysis,” Journal of the American Geriatrics Society 70, no. 5 (2022): 1325–1335.
10.1111/jgs.17762
PubMedWeb of Science®Google Scholar
3 Why is Home Healthcare Growing So Fast? (AMN Healthcare, 2022).
Google Scholar
4 National Association for Home Care & Hospice, Basic Statistics About Home Care (National Association for Home Care & Hospice, 2010), updated July 10, 2024, http://www.nahc.org/wp-content/uploads/2017/10/10hc_stats.pdf.
Google Scholar
5D. M. Siclovan, “The Effectiveness of Home Health Care for Reducing Readmissions: An Integrative Review,” Home Health Care Services Quarterly 37, no. 3 (2018): 187–210.
10.1080/01621424.2018.1472702
PubMedGoogle Scholar
6I. Megido, Y. Sela, and K. Grinberg, “Cost Effectiveness of Home Care Versus Hospital Care: A Retrospective Analysis,” Cost Effectiveness and Resource Allocation 21, no. 1 (2023): 13.
10.1186/s12962-023-00424-0
PubMedWeb of Science®Google Scholar
7C. Curioni, A. C. Silva, J. Damiao, et al., “The Cost-Effectiveness of Homecare Services for Adults and Older Adults: A Systematic Review,” International Journal of Environmental Research and Public Health 20, no. 4 (2023): 3373.
10.3390/ijerph20043373
PubMedGoogle Scholar
8H. M. Krumholz, “Post-Hospital Syndrome–An Acquired, Transient Condition of Generalized Risk,” New England Journal of Medicine 368, no. 2 (2013): 100–102.
10.1056/NEJMp1212324
CASPubMedWeb of Science®Google Scholar
9M. O'Connor, A. Hanlon, and K. H. Bowles, “Impact of Frontloading of Skilled Nursing Visits on the Incidence of 30-Day Hospital Readmission,” Geriatric Nursing 35, no. 2 S (2014): S37–S44.
10.1016/j.gerinurse.2014.02.018
PubMedGoogle Scholar
10C. M. Murtaugh, P. Deb, C. Zhu, et al., “Reducing Readmissions Among Heart Failure Patients Discharged to Home Health Care: Effectiveness of Early and Intensive Nursing Services and Early Physician Follow-Up,” Health Services Research 52, no. 4 (2017): 1445–1472.
10.1111/1475-6773.12537
PubMedWeb of Science®Google Scholar
11S. L. Hughes, A. Ulasevich, F. M. Weaver, et al., “Impact of Home Care on Hospital Days: A meta Analysis,” Health Services Research 32, no. 4 (1997): 415–432.
CASPubMedWeb of Science®Google Scholar
12 Centers for Medicare & Medicaid Services, Home Health Benefit (Centers for Medicare & Medicaid Services, 2014), https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2014-12-16-HHBenefit-HL.pdf.
Google Scholar
13 Home Health Chartbook 2023 (Research Institute for Home Care, 2023).
Google Scholar
14M. C. Lohman, E. A. Scherer, K. L. Whiteman, R. L. Greenberg, and M. L. Bruce, “Factors Associated With Accelerated Hospitalization and Re-Hospitalization Among Medicare Home Health Patients,” Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 73, no. 9 (2018): 1280–1286.
10.1093/gerona/glw335
PubMedWeb of Science®Google Scholar
15M. Topaz, Y. Barron, J. Song, et al., “Risk of Rehospitalization or Emergency Department Visit is Significantly Higher for Patients Who Receive Their First Home Health Care Nursing Visit Later Than 2 Days After Hospital Discharge,” Journal of the American Medical Directors Association 23, no. 10 (2022): 1642–1647.
10.1016/j.jamda.2022.07.001
PubMedWeb of Science®Google Scholar
16J. Li, M. Qi, and R. M. Werner, “Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults,” JAMA Network Open 3, no. 9 (2020): e2015470.
10.1001/jamanetworkopen.2020.15470
PubMedWeb of Science®Google Scholar
17J. Song, M. Zolnoori, M. V. McDonald, et al., “Factors Associated With Timing of the Start-Of-Care Nursing Visits in Home Health Care,” Journal of the American Medical Directors Association 22, no. 11 (2021): 2358–2365 e2353.
10.1016/j.jamda.2021.03.005
PubMedWeb of Science®Google Scholar
18D. Jung, S. Song, and C. Ma, “Where Patients Live Matter in Emergency Department Visits in Home Health Care: Rural/Urban Status and Neighborhood Socioeconomic Status,” Journal of Applied Gerontology 43, no. 7 (2024): 933–944.
10.1177/07334648231216644
PubMedWeb of Science®Google Scholar
19D. Jung, J. Rajbhandari-Thapa, and Z. Chen, “Disparities in Successful Discharge to the Community Following Use of Medicare Home Health by Level of Neighborhood Socioeconomic Disadvantage,” Journal of Applied Gerontology 42, no. 10 (2023): 2119–2128.
10.1177/07334648231172677
PubMedWeb of Science®Google Scholar
20J. B. Lusk, M. N. Hoffman, A. G. Clark, et al., “Neighborhood Socioeconomic Disadvantage, Healthcare Access, and Outcomes of Hospitalizations for Common Pulmonary Conditions: A National Study of Medicare Beneficiaries,” Annals of the American Thoracic Society 20, no. 10 (2023): 1416–1424.
10.1513/AnnalsATS.202304-310OC
PubMedWeb of Science®Google Scholar
21Z. Hermes, K. E. Joynt Maddox, R. W. Yeh, Y. Zhao, C. Shen, and R. K. Wadhera, “Neighborhood Socioeconomic Disadvantage and Mortality Among Medicare Beneficiaries Hospitalized for Acute Myocardial Infarction, Heart Failure, and Pneumonia,” Journal of General Internal Medicine 37, no. 8 (2022): 1894–1901.
10.1007/s11606-021-07090-z
PubMedWeb of Science®Google Scholar
22P. Galiatsatos, A. Follin, F. Alghanim, et al., “The Association Between Neighborhood Socioeconomic Disadvantage and Readmissions for Patients Hospitalized With Sepsis,” Critical Care Medicine 48, no. 6 (2020): 808–814.
10.1097/CCM.0000000000004307
PubMedWeb of Science®Google Scholar
23 Educational Development Corporation, Access to Health Care in NYC: Borough Inequality and the Pandemic Effect (Educational Development Corporation, 2020), accessed August 2, 2024, https://edc.nyc/research-insights/access-health-care-nyc-borough-inequality-pandemic-effect.
Google Scholar
24 Kaiser Family Foundation, Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity (Kaiser Family Foundation, 2023), https://www.kff.org/racial-equity-and-health-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/.
Google Scholar
25E. Ward, A. Jemal, V. Cokkinides, et al., “Cancer Disparities by Race/Ethnicity and Socioeconomic Status,” CA: A Cancer Journal for Clinicians 54, no. 2 (2004): 78–93.
10.3322/canjclin.54.2.78
CASPubMedWeb of Science®Google Scholar
26A. J. H. Kind and W. R. Buckingham, “Making Neighborhood-Disadvantage Metrics Accessible – The Neighborhood Atlas,” New England Journal of Medicine 378, no. 26 (2018): 2456–2458.
10.1056/NEJMp1802313
PubMedWeb of Science®Google Scholar
27 2020 Area Deprivation Index v4.0.1 (University of Wisconsin School of Medicine and Public Health, 2020), accessed August 2, 2024, https://www.neighborhoodatlas.medicine.wisc.edu.
Google Scholar
28B. J. Moore, S. White, R. Washington, N. Coenen, and A. Elixhauser, “Identifying Increased Risk of Readmission and in-Hospital Mortality Using Hospital Administrative Data: The AHRQ Elixhauser Comorbidity Index,” Medical Care 55, no. 7 (2017): 698–705.
10.1097/MLR.0000000000000735
PubMedWeb of Science®Google Scholar
29J. M. Smith, H. Lin, C. Thomas-Hawkins, J. Tsui, and O. F. Jarrin, “Timing of Home Health Care Initiation and 30-Day Rehospitalizations Among Medicare Beneficiaries With Diabetes by Race and Ethnicity,” International Journal of Environmental Research and Public Health 18, no. 11 (2021): 5623, https://doi.org/10.3390/ijerph18115623.
10.3390/ijerph18115623
PubMedWeb of Science®Google Scholar
30D. D. Quigley, A. M. Chastain, J. A. Kang, et al., “Systematic Review of Rural and Urban Differences in Care Provided by Home Health Agencies in the United States,” Journal of the American Medical Directors Association 23, no. 10 (2022): 1653.e1–1653.e13.
10.1016/j.jamda.2022.08.011
PubMedWeb of Science®Google Scholar
31J. A. Nelson and B. Stover Gingerich, “Rural Health: Access to Care and Services,” Home Health Care Management & Practice 22, no. 5 (2010): 339–343.
10.1177/1084822309353552
Google Scholar
32M. Rahman, E. M. White, K. S. Thomas, and E. Jutkowitz, “Assessment of Rural-Urban Differences in Health Care Use and Survival Among Medicare Beneficiaries With Alzheimer Disease and Related Dementia,” JAMA Network Open 3, no. 10 (2020): e2022111.
10.1001/jamanetworkopen.2020.22111
PubMedWeb of Science®Google Scholar

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Disparities in Timely Receipt of Home Healthcare: Neighborhood Disadvantage and Delayed Start-of-Care Visits in New York City

ABSTRACT

Background

Methods

Results

Conclusions

Conflicts of Interest

Supporting Information

References

References

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Disparities in Timely Receipt of Home Healthcare: Neighborhood Disadvantage and Delayed Start-of-Care Visits in New York City

ABSTRACT

Background

Methods

Results

Conclusions

Conflicts of Interest

Supporting Information

References

References

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