National Healthcare Quality and Disparities Report
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Topics
- Access to Care (2)
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- Stroke (1)
- Training (1)
- Transitions of Care (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 16 of 16 Research Studies DisplayedDuan KI, Wong ES, Liao JM
Long-term trends in home respiratory medical equipment among U.S. Medicare patients.
The purpose of this study was to explore how respiratory durable medical equipment (DME) supply has changed since Medicare implemented the Competitive Bidding Program (CBP) in 2011and increased the scale of the program nationally in 2013 and 2016. The researchers analyzed all publicly available nationwide Medicare DME data from 2013 to 2019 and analyzed all respiratory DME included in the CBP (excluding accessories such as masks, tubing, and filters). The researchers found that the three highest-volume respiratory DME products were stationary oxygen concentrators, continuous positive airway pressure (CPAP) devices, and gaseous portable oxygen. Decreases in suppliers across all items and increases in claims per supplier for the majority of items suggest greater market concentration of respiratory DME suppliers for Medicare beneficiaries. Even as the Medicare population expanded by 2.6% between 2013 and 2019, the number of patients receiving home oxygen decreased, results that could represent reduced access to home oxygen DME. Finally, in contrast to declines in use for most home oxygen items, the percentage of Medicare beneficiaries using portable oxygen concentrators and CPAP devices increased significantly. The researchers conclude that this analysis addresses a critical knowledge gap and highlights the need for future work evaluating how policies such as the CBP affect respiratory DME access and outcomes.
AHRQ-funded; HS026369.
Citation: Duan KI, Wong ES, Liao JM .
Long-term trends in home respiratory medical equipment among U.S. Medicare patients.
Am J Respir Crit Care Med 2022 Aug 15;206(4):509-11. doi: 10.1164/rccm.202202-0238LE..
Keywords: Home Healthcare, Medicare, Respiratory Conditions
Smith JM, Lin H, Thomas-Hawkins C
Timing of home health care initiation and 30-day rehospitalizations among Medicare beneficiaries with diabetes by race and ethnicity.
Older adults with diabetes are at elevated risk of complications following hospitalization. Home health care services mitigate the risk of adverse events and facilitate a safe transition home. In the United States, when home health care services are prescribed, federal guidelines require they begin within two days of hospital discharge. This study examined the association between timing of home health care initiation and 30-day rehospitalization outcomes in a cohort of 786,734 Medicare beneficiaries following a diabetes-related index hospitalization admission during 2015.
AHRQ-funded; HS022406.
Citation: Smith JM, Lin H, Thomas-Hawkins C .
Timing of home health care initiation and 30-day rehospitalizations among Medicare beneficiaries with diabetes by race and ethnicity.
Int J Environ Res Public Health 2021 May 25;18(11). doi: 10.3390/ijerph18115623..
Keywords: Elderly, Home Healthcare, Hospital Readmissions, Medicare, Diabetes, Chronic Conditions, Racial and Ethnic Minorities
Reistetter TA, Eschbach K K, Prochaska J
Understanding variation in postacute care: developing rehabilitation service areas through geographic mapping.
This study’s goal was to demonstrate a method for developing rehabilitation service areas for post-acute care. A secondary analysis of 2013-2014 Medicare records for older patients in Texas (n = 469,172) was conducted. The analysis included admission records for inpatient rehabilitation facilities, skilled nursing facilities, and long-term care hospitals. The authors used Ward’s algorithm to cluster patient ZIP code tabulation areas based on which facilities patients were admitted to for rehabilitation. They set the number of rehabilitation clusters to 22 to allow for comparison to the 22 hospital referral regions. Interclass Correlation Coefficient (ICC) and variance in the number of rehabilitation beds across areas were the methods used to evaluate rehabilitation service areas. The service areas had a higher ICC and variance in beds than the hospital referral regions.
AHRQ-funded; HS024711.
Citation: Reistetter TA, Eschbach K K, Prochaska J .
Understanding variation in postacute care: developing rehabilitation service areas through geographic mapping.
Am J Phys Med Rehabil 2021 May;100(5):465-72. doi: 10.1097/phm.0000000000001577..
Keywords: Elderly, Rehabilitation, Medicare, Nursing Homes, Long-Term Care, Home Healthcare, Access to Care
Burgdorf JG, Stuart EA, Arbaje AI
Family caregiver training needs and Medicare home health visit utilization.
This study looked at family caregiver training needs and Medicare home health visit utilization. Medicare home health providers are now required to give family caregiver training, but service intensity is not known. This observational study linked National Health and Aging Trends Study (NHATS), Outcomes and Assessment Information (OASIS), and Medicare claims data to evaluate the relationship between caregivers’ training needs and number/type of home health visits. A total of 1217 NHATS participants receiving Medicare-funded home health between 2011 and 2016 were included. Nurse visits were more likely when family caregivers had medication management or household chore training needs. Therapy visits were more likely when caregivers had self-care training needs. Aide visits were more likely when caregivers had household chore or self-care training needs. Medication management training needs resulted in an additional 1.06 nursing visits, and household chore training an additional 3.24 total and a subset of 1.32 aide visits.
AHRQ-funded; HS000029.
Citation: Burgdorf JG, Stuart EA, Arbaje AI .
Family caregiver training needs and Medicare home health visit utilization.
Med Care 2021 Apr;59(4):341-47. doi: 10.1097/mlr.0000000000001487..
Keywords: Caregiving, Elderly, Home Healthcare, Medicare, Training, Healthcare Utilization
Wang J, Ying M, Temkin-Greener H
Utilization and functional outcomes among Medicare home health recipients varied across living situations.
Home health (HH) is a major type of home-based skilled care available to Medicare beneficiaries. In this study, the investigators examined the association between living situation and utilization and functional outcomes among Medicare HH recipients. The investigators concluded that, in the study population, patients living with others at home had the highest risk of hospitalization and ED visits, whereas assisted living (AL) residents had the lowest risk of hospitalization and patients living alone at home had the lowest risk of ED visits.
AHRQ-funded; HS026893.
Citation: Wang J, Ying M, Temkin-Greener H .
Utilization and functional outcomes among Medicare home health recipients varied across living situations.
J Am Geriatr Soc 2021 Mar;69(3):704-10. doi: 10.1111/jgs.16949..
Keywords: Home Healthcare, Medicare, Outcomes
Nazareno J, Zhang W, Silver B
Home health utilization in assisted living settings.
The authors explored the growth in the delivery of home health agency (HHA) services to Medicare beneficiaries in assisted living (AL) compared with other home settings between 2012 and 2014. Their findings suggested that there was a slight growth in the share of HHA services being delivered in AL. HHA recipients in AL were more likely to have cognitive and activities of daily living impairments than those receiving HHA services in other settings. This study is among the first of those to examine HHA utilization in AL.
AHRQ-funded; HS000011.
Citation: Nazareno J, Zhang W, Silver B .
Home health utilization in assisted living settings.
Med Care Res Rev 2020 Dec;77(6):620-29. doi: 10.1177/1077558719835049..
Keywords: Elderly, Home Healthcare, Medicare, Healthcare Utilization
Mroz TM, Patterson DG, Frogner BK
The impact of Medicare's rural add-on payments on supply of home health agencies serving rural counties.
This analysis looked at the impact of Medicare’s rural add-on payments on supply of home health agencies serving rural counties. The authors used data from Home Health Compare. The results suggest that while supply changes are similar in rural counties adjacent to urban areas and urban counties regardless of add-on payments, only higher add-payments of 5 to 10 percent to rural counties keep them on pace with those in urban counties.
AHRQ-funded; HS024777.
Citation: Mroz TM, Patterson DG, Frogner BK .
The impact of Medicare's rural add-on payments on supply of home health agencies serving rural counties.
Health Aff 2020 Jun;39(6):949-57. doi: 10.1377/hlthaff.2019.00952..
Keywords: Elderly, Medicare, Home Healthcare, Rural Health, Payment, Access to Care
Jarrin OF, Nyandege AN, Grafova IB
Validity of race and ethnicity codes in Medicare administrative data compared with gold-standard self-reported race collected during routine home health care visits.
The authors compared the validity of two race/ethnicity variables found in Medicare administrative data against a gold-standard source also available in the Medicare data warehouse. They found that the race/ethnicity variables contained in Medicare administrative data for minority health disparities research can be improved through the use of self-reported race/ethnicity data. They conclude that future work to improve the accuracy of Medicare beneficiaries' race/ethnicity data should incorporate and augment the self-reported race/ethnicity data contained in assessment and survey data, available within the Medicare data warehouse.
AHRQ-funded; HS022406.
Citation: Jarrin OF, Nyandege AN, Grafova IB .
Validity of race and ethnicity codes in Medicare administrative data compared with gold-standard self-reported race collected during routine home health care visits.
Med Care 2020 Jan;58(1):e1-e8. doi: 10.1097/mlr.0000000000001216..
Keywords: Racial and Ethnic Minorities, Home Healthcare, Medicare, Data, Disparities, Research Methodologies
Jones CD, Falvey J, Hess E
Predicting hospital readmissions from home healthcare in Medicare beneficiaries.
The authors used patient-level clinical variables to develop and validate a parsimonious model to predict hospital readmissions from home healthcare (HHC) in Medicare fee-for-service beneficiaries. They found that variables available to HHC clinicians at the first post-discharge HHC visit can predict readmission risk and inform care plans in HHC. They recommend that future analyses incorporating measures of social determinants of health, such as housing instability or social support, have the potential to enhance prediction of this outcome.
AHRQ-funded; HS024569.
Citation: Jones CD, Falvey J, Hess E .
Predicting hospital readmissions from home healthcare in Medicare beneficiaries.
J Am Geriatr Soc 2019 Dec;67(12):2505-10. doi: 10.1111/jgs.16153..
Keywords: Home Healthcare, Hospital Readmissions, Medicare, Elderly, Transitions of Care
Gorges RJ, Sanghavi P, Konetzka RT
A national examination of long-term care setting, outcomes, and disparities among elderly dual eligibles.
The authors investigated the outcomes of expanding Medicaid funding for long-term care home and community-based services (HCBS). Using national Medicaid claims data on older adults enrolled in both Medicare and Medicaid, they found that overall hospitalization rates were similar for HCBS and nursing facility users. They concluded that home and community-based services need to be carefully targeted to avoid adverse outcomes and that the racial/ethnic disparities in access to high-quality institutional long-term care are also present in HCBS.
AHRQ-funded; HS000084.
Citation: Gorges RJ, Sanghavi P, Konetzka RT .
A national examination of long-term care setting, outcomes, and disparities among elderly dual eligibles.
Health Aff 2019 Jul;38(7):1110-18. doi: 10.1377/hlthaff.2018.05409..
Keywords: Elderly, Medicaid, Medicare, Long-Term Care, Home Healthcare, Disparities, Racial and Ethnic Minorities
Jones CD, Bowles KH, Richard A
High-value home health care for patients with heart failure: an opportunity to optimize transitions from hospital to home.
Providing home health nursing and therapy could promote recovery in vulnerable HF patients with post-hospital syndrome and potentially reduce readmissions. The authors argue that understanding the characteristics of effective post-acute HHC for patients with HF will inform best practices, optimal outcomes for cost, and ultimately high-value care.
AHRQ-funded; HS024569.
Citation: Jones CD, Bowles KH, Richard A .
High-value home health care for patients with heart failure: an opportunity to optimize transitions from hospital to home.
Circ Cardiovasc Qual Outcomes 2017 May;10(5). doi: 10.1161/circoutcomes.117.003676.
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Keywords: Home Healthcare, Heart Disease and Health, Transitions of Care, Care Coordination, Medicare
Fonarow GG, Liang L, Thomas L
Assessment of home-time after acute ischemic stroke in Medicare beneficiaries.
The researchers evaluated home-time as a patient-centered outcome in Medicare beneficiaries with ischemic stroke in comparison with modified Rankin Scale (mRS) score at 90 days and at 1 year post event. They concluded that in a population of older patients with ischemic stroke, home-time was readily available from administrative data and associated with mRS at 90 days and 1 year.
AHRQ-funded; HS019479; HS016964.
Citation: Fonarow GG, Liang L, Thomas L .
Assessment of home-time after acute ischemic stroke in Medicare beneficiaries.
Stroke 2016 Mar;47(3):836-42. doi: 10.1161/strokeaha.115.011599.
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Keywords: Medicare, Stroke, Elderly, Home Healthcare, Patient-Centered Outcomes Research
Jubelt LE, Goldfeld KS, Chung WY
Changes in discharge location and readmission rates under Medicare bundled payment.
To control costs, NYU Langone Medical Center attempted to shift referrals from facility-based to home-based postacute care. In the context of this shift in referrals, the researchers examined the change in hospital readmission rates. Their findings suggest that institutions may be able to shift some patients from facility-based to home-based postacute care without adversely affecting hospital readmission rates or the length of hospital stay.
AHRQ-funded; HS023683; HS022882.
Citation: Jubelt LE, Goldfeld KS, Chung WY .
Changes in discharge location and readmission rates under Medicare bundled payment.
JAMA Intern Med 2016 Jan;176(1):115-7. doi: 10.1001/jamainternmed.2015.6265.
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Keywords: Medicare, Hospital Discharge, Hospital Readmissions, Home Healthcare, Healthcare Costs
Rahman M, Keohane L, Trivedi AN
High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare.
The investigators examined the rates at which participants who used three high-cost services switched between Medicare Advantage and traditional Medicare. They found that the switching rate from 2010 to 2011 away from Medicare Advantage and to traditional Medicare exceeded the switching rate in the opposite direction for participants who used long-term nursing home care, short-term nursing home care, and home health care. These results were magnified among people who were enrolled in both Medicare and Medicaid.
AHRQ-funded; HS000011.
Citation: Rahman M, Keohane L, Trivedi AN .
High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare.
Health Aff 2015 Oct;34(10):1675-81. doi: 10.1377/hlthaff.2015.0272.
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Keywords: Healthcare Costs, Home Healthcare, Long-Term Care, Medicare, Nursing Homes
Huckfeldt PJ, Sood N, Escarce JJ
Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.
The researchers contrasted the effects of two Medicare payment reforms for home health agencies: the interim payment system (IPS) and the prospective payment system (PPS). The 1997 IPS reform lowered payments for both fee-for-service and episode-based care, as predicted by their conceptual model. The PPS in 2000 raised average but lowered marginal payment.
AHRQ-funded; HS018541
Citation: Huckfeldt PJ, Sood N, Escarce JJ .
Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.
J Health Econ. 2014 Mar;34:1-18. doi: 10.1016/j.jhealeco.2013.11.005..
Keywords: Medicare, Healthcare Costs, Home Healthcare
Huckfeldt PJ, Sood NB, Romley JA
Medicare payment reform and provider entry and exit in the post-acute care market.
The researchers examined the impact of Medicare payment reform on the entry and exit of post-acute providers (home health agencies and skilled nursing facilities). They found that payment reforms reducing average and marginal payments reduced entries and increased exits from the market, with entries more likely to be affected.
AHRQ-funded; HS018541
Citation: Huckfeldt PJ, Sood NB, Romley JA .
Medicare payment reform and provider entry and exit in the post-acute care market.
Health Serv Res. 2013 Oct;48(5):1557-80. doi: 10.1111/1475-6773.12059..
Keywords: Medicare, Critical Care, Healthcare Costs, Home Healthcare, Long-Term Care