Equity in the Advanced Care at Home Model In an Integrative Healthcare System

Abstract

Advanced Care at Home (ACAH) provides hospital-level care as a substitute for traditional facility-based hospital care. However, there are still concerns regarding equity of care to different socioeconomic groups for this model of care. This retrospective cohort study compared socioeconomic indicators between typical hospital care and an ACAH model in an integrated healthcare system. By utilizing demographics, Neighborhood Deprivation Index (NDI), Medical Financial Aid (MFA) status, and insurance status as proxies for socioeconomic status, our data suggests that care was provided at similar rates to traditional hospital care regardless of age, race, ethnicity, insurance status or degree of social deprivation. In patients in the 4th of 5 NDI quintiles (higher socioeconomic needs), a higher percentage were treated in the ACAH model (20.4% vs. 14.2%; P < 0.00001). 16.9% of Kaiser Permanente at Home patients had applied for MFA within 6 months of admission compared with 13.5% of hospital patients (P = 0.00001).