Racial differences in the quality of home health care: What are the contributing factors?

摘要

Background: Racial disparities in the quality of care have been documented in numerous health care settings. However, there are no published studies in which quality of care has been compared between home healthcare agencies that serve a high and low percentage of African American patients ( High and Low AA HHAs).;Objective: Guided by the theory of institutional racism, the overall purpose of this study was two-fold: to document whether racial differences in the quality of home health care exist and, if found, explore the relationship between market, community, organizational, nurse staffing characteristics and racial differences in quality of care.;Methods: This study employed a retrospective, non-experimental, descriptive design. There were five data sets: the Outcome and Assessment Information Set, the Provider of Services File, the Area Resource File, the Healthcare Cost Report Information System, and Home Health Compare. Four analyses were conducted: two descriptive analyses to compare patient characteristics between High and Low AA HHAs and to compare quality of care measures between High and Low AA HHAs; a multiple regression analysis to assess which characteristics (market, community, organizational, nurse staffing) influence differences in quality of care; and a logistic regression analysis to examine variation in quality among High AA HHAs..;Results: High AA HHAs were located in counties with a larger African American population and a higher number of unemployed persons and were more likely to be for-profit and have been Medicare certified for fewer years compared to Low AA HHAs. High AA HHAs had lower quality of care scores for two of the six outcome measures. Community and organizational characteristics were more likely to be associated with observed racial differences than were market and nurse staffing characteristics. Organizational characteristics had more influence on variation in quality of care for High AA HHAs compared to market, community, and nurse staffing characteristics.;Conclusions: This study provided mixed evidence that differences in quality of home health care exist between High and Low AA HHAs. However, additional studies are needed to further our understanding of how policies and practices of social institutions can perpetuate racial differences in the quality of health care.