ArticleHealth services research2024
Getting to the root: Examining within and between home health agency inequities in functional improvement.
Article in Health services research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Post-Acute Care Trends and Disparities After Joint Replacements in the United States, 1991-2018: A Systematic Review.Journal of the American Medical Directors Association · 2024Pooled it
- Factors Associated With an Elder Mistreatment Diagnosis Among Medicare Home Health Care Recipients.Journal of the American Medical Directors Association · 2025Article
- Medicare Advantage reimbursement structures impact home health delivery and outcomes.The American journal of managed care · 2025Article
- Racial and Ethnic Disparities in Accessing High-Quality Home Health Care among Older Adults with and Without Dementia.Journal of the American Medical Directors Association · 2025Article
- Discharge disposition for home health care patients with Alzheimer's disease and related dementia: The role of living arrangements and rural living.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- Home Health Care and Place of Death in Medicare Beneficiaries With and Without Dementia.The Gerontologist · 2024Article
- Getting to the root: Examining within and between home health agency inequities in functional improvement.Health services research · 2024Article
- Hospital Discharge Planners Need More Information When Referring Patients to Home Health Care: Insights From the Coronavirus Disease 2019 Pandemic.Health services insights · 2023Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectiveTo quantify racial, ethnic, and income-based disparities in home health (HH) patients' functional improvement within and between HH agencies (HHAs). DATA SOURCES: 2016-2017 Outcome and Assessment Information Set, Medicare Beneficiary Summary File, and Census data. DATA COLLECTION/EXTRACTION
methodsNot Applicable. STUDY
designWe use multinomial-logit analyses with and without HHA fixed effects. The outcome is a mutually exclusive five-category outcome: (1) any functional improvement, (2) no functional improvement, (3) death while a patient, (4) transfer to an inpatient setting, and (5) continuing HH as of December 31, 2017. The adjusted outcome rates are calculated by race, ethnicity, and income level using predictive margins. PRINCIPAL
findingsOf the 3+ million Medicare beneficiaries with a HH start-of-care assessment in 2016, 77% experienced functional improvement at discharge, 8% were discharged without functional improvement, 0.6% died, 2% were transferred to an inpatient setting, and 12% continued using HH. Adjusting for individual-level characteristics, Black, Hispanic, American Indian/Alaska Native (AIAN), and low-income HH patients were all more likely to be discharged without functional improvement (1.3 pp [95% CI: 1.1, 1.5], 1.5 pp [95% CI: 0.8, 2.1], 1.2 pp [95% CI: 0.6, 1.8], 0.7 pp [95% CI:0.5, 0.8], respectively) compared to White and higher income patients. After including HHA fixed effects, the differences for Black, Hispanic, and AIAN HH patients were mitigated. However, income-based disparities persisted within HHAs. Black-White, Hispanic-White, and AIAN-White disparities were largely driven by between-HHA differences, whereas income-based disparities were mostly due to within-HHA differences, and Asian American/Pacific Islander patients did not experience any observable disparities.
conclusionsBoth within- and between-HHA differences contribute to the overall disparities in functional improvement. Mitigating functional improvement inequities will require a diverse set of culturally appropriate and socially conscious interventions. Improving the quality of HHAs that serve more marginalized patients and incentivizing improved equity within HHAs are approaches that are imperative for ameliorating outcomes.
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