• Cara Murez
• Posted January 10, 2022

Quality of Home Health Care Varies Between Urban, Rural Areas

Need in-home health care? Know this: The quality of your care may depend on where you live.

That's the takeaway from a new study from New York University that gave agencies in urban areas high marks for keeping patients out of the hospital. It found that home health agencies in rural areas, meanwhile, get care started sooner.

"Our study highlights the persistence of disparities in quality of home health care," said study author Chenjuan Ma, an assistant professor at NYU's Rory Meyers College of Nursing.

For the study, her team analyzed performance measures from the U.S. Centers for Medicare and Medicaid Services between 2014 and 2018.

Limited improvements have been made over time, and gaps in quality of care did not significantly shrink over the period, researchers found.

They analyzed data from 7,908 home health agencies, of which nearly 20% were in rural areas. Quality measures included timely initiation of care, a process measure, and hospitalization and ER visits, which are outcome measures.

Researchers found that rural agencies consistently began home care quickly -- either upon a doctor's orders or within two days of hospital discharge or referral.

But urban agencies consistently performed better on preventing hospitalization and emergency room visits for home care patients.

Over the five years studied, ER visits rose for both urban and rural home health agencies, however.

The geographic gaps were steady over time except for hospitalization, which narrowed slightly, researchers said.

Home health care is care delivered in the home of a patient, typically by nurses. It is among the fastest-growing health care sectors in the United States.

In 2018, more than 5 million Medicare beneficiaries received home health care. About 9% lived in rural areas.

"Providing early, intensive visits to patients during a home health episode has been shown to be effective in reducing hospitalization and improving functional status, so timely initiation of care is a critical component of quality home care for patients," Ma said in a university news release. "Strong relationships between rural home health agencies and local hospitals, as evidenced in previous research, may be facilitating the timely initiation of home health care to rural patients."

Researchers said it's important to take into account the geographic, staffing and health challenges facing agencies.

Providers from rural home health agencies often spend significant time traveling to and from patient homes, which could result in less efficient care delivery. They also have staffing and resource challenges. Rural patients are in poorer overall health status than urban patients, the study also noted.

The findings were published Jan. 6 in the Journal of Rural Health.

More information

The U.S. Centers for Medicare and Medicaid Services has more information about home health care.

SOURCE: New York University, news release, Jan. 6, 2022