Quality of Home Health Care: A Rural-Urban Comparison. Abstract, Executive Summary and Final Report

摘要

In this study, quality was measured by patient outcomes, primarily discharge status and end-result outcomes (e.g., improvement in ambulation between admission and discharge). The analyses involved primary and secondary data from 1995-96 on over 7200 rural and urban elderly (age 65 and over) patients nationally. Longitudinal patient-level data covered from home health care admission to discharge or 120 days (whichever occurred first). The findings suggest less favorable (case mix-adjusted) rural outcomes. Although end-result outcome rates were similar for rural and urban nonhospitalized patients, rural patients had lower rates of discharge with goals met and higher rates of hospitalization. In addition, total visits and resource consumption (also case mix adjusted) were lower for rural compared to urban patients. The combination of less favorable rural outcomes and fewer visits for rural patients highlights the importance of monitoring outcomes under the Medicare home health Prospective Payment System (PPS), which creates strong financial incentives for providers to minimize services within each payment episode. Rural patients may be particularly vulnerable to further service reductions.