Association Between Race, Neighborhood, and Medicaid Enrollment and Outcomes in Medicare Home Health Care.

More than 3 million Medicare beneficiaries use home health care annually, yet little is known about how vulnerable beneficiaries fare in the home health setting. This is particularly important given the recent launch of Medicare's Home Health Value-Based Purchasing model. The objective of this study was to determine odds of adverse clinical outcomes associated with dual enrollment in Medicaid and Medicare as a marker of individual poverty, residence in a low-income ZIP code tabulation area (ZCTA), and black race. Retrospective observational study using individuals-level logistic regression. Home health care. Fee-for-service Medicare beneficiaries from 2012 to 2014. Thirty- and 60-day clinical outcomes, including readmissions, admissions, and emergency department (ED) use. Home health agencies serving a high proportion of dually enrolled, low-income ZCTA, or black beneficiaries were less often high-quality. Dually-enrolled, low-income ZCTA, and Black beneficiaries receiving home health care after hospitalization had higher risk-adjusted odds of 30-day readmission (odds ratio [OR] = 1.08, P < 0.001; OR = 1.03, P < 0.001; and OR = 1.02, P = 0.002 respectively) and 30-day ED use (OR = 1.20, 1.07, and 1.15, P < 0.001 for each). Those receiving home health care without preceding hospitalization had higher 60-day admission (OR = 1.06, P < 0.001; OR = 1.01, P = 0.002; and OR = 1.05, P < 0.001), and 60-day ED use (OR = 1.16, 1.03, and 1.19, P < 0.001 for each). Differences were primarily within agencies rather than between the agencies where these beneficiaries sought care. Medicare beneficiaries receiving home health services who are dually enrolled, live in a low-income neighborhood, or are black have higher rates of adverse clinical outcomes. These populations may be an important target for quality improvement under Home Health Value-Based Purchasing.

Joynt Maddox KE ，Chen LM ，Zuckerman R ，Epstein AM ... -  《-》

Thirty-day readmission rates for Medicare beneficiaries by race and site of care.

Joynt KE ，Orav EJ ，Jha AK 《-》

The Impact of Race and Neighborhood Racial Composition on Preventable Readmissions for Diabetic Medicare Home Health Beneficiaries.

Chen HF ，Homan S ，Carlson E ，Popoola T ，Radhakrishnan K ... -  《-》

Assessment of Receipt of the First Home Health Care Visit After Hospital Discharge Among Older Adults.

Li J ，Qi M ，Werner RM 《-》

Disparities in surgical 30-day readmission rates for Medicare beneficiaries by race and site of care.

Tsai TC ，Orav EJ ，Joynt KE 《-》