Dual Medicaid enrollment, low-income neighborhood residence, and Black race were associated with higher odds of 30-day readmission (OR 1.08, 1.03, and 1.02, respectively) in home health care.
Observational
Yes
Do dual Medicaid enrollment, low-income neighborhood residence, and black race increase the risk of adverse clinical outcomes in Medicare beneficiaries receiving home health care?
Vulnerable Medicare beneficiaries (dually enrolled, low-income neighborhood, or black) receiving home health care have higher rates of adverse clinical outcomes, primarily driven by differences within agencies.
Odds Ratio: 1.08
p-value: p=<0.001
BACKGROUND/OBJECTIVES: 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. DESIGN: Retrospective observational study using individuals-level logistic regression. SETTING: Home health care. PARTICIPANTS: Fee-for-service Medicare beneficiaries from 2012 to 2014. MEASUREMENTS: Thirty- and 60-day clinical outcomes, including readmissions, admissions, and emergency department (ED) use. RESULTS: 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. CONCLUSION: 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.
Maddox et al. (Wed,) conducted a observational in Home health care. Dual Medicaid/Medicare enrollment, low-income neighborhood residence, or Black race vs. Beneficiaries without these characteristics was evaluated on 30-day readmission after hospitalization (OR 1.08, p=<0.001). Dual Medicaid enrollment, low-income neighborhood residence, and Black race were associated with higher odds of 30-day readmission (OR 1.08, 1.03, and 1.02, respectively) in home health care.