Relationships of Rurality, Home Health Care Use, and Outcomes

Abstract

Rural elders have a disproportionate prevalence of illness and limited access to health services. The purpose of this study is to determine whether degree of rurality and home health care use influences home health care patient outcomes. An adaptation of the Outcomes Model for Health Care Research provided the framework for the study. A stratified random sample was selected from a database of risk-adjusted publicly reported patient outcomes from Medicare-certified home health care agencies and merged with agency factors from Medicare cost reports and U.S. Census data. Path analysis was performed to evaluate the relationships in the model. Hospitalization is the only outcome variable associated with community and agency characteristics or home health care use. Rurality does not have a direct effect on hospitalization; however, increased visits per patient and low-income community status are associated with increased hospitalization. Rurality may not have a direct effect on outcomes but instead acts through health care services.

Quality of Care and Job Satisfaction in the European Home Care Setting: Research Protocol

“…The questionnaire on the characteristics of the home care organisations was developed on evidence-based literature on community care organisations and quality of care [59606162636465]. Elements concerning integrated care were included based on the theoretical framework of the Care Coordination Atlas [65].…”

Disparities in home health service providers among Medicare beneficiaries with stroke

“…Between 2002 and 2010, an increasing proportion of both urban and rural beneficiaries used HH services; in 2011 and 2012, these proportions declined, coincident with drops in payment per episode (MEDPAC, 2014b, Table 6). Rural HH agencies are particularly susceptible to payment changes given the higher operating costs, limited availability of providers, and long travel distances (Sutton, 2005a;Vanderboom & Madigan, 2008).…”

“…Some studies indicate that rural beneficiaries used more Medicare HH services (McAuley, Spector, Van Nostrand, & Shaffer, 2004), received more HH visits per episode (Kenney, 1993b), and had more direct care time (Adams et al, 2001) compared to their urban peers. Other studies suggested that rural beneficiaries received fewer HH services compared to urban beneficiaries (Kenney, 1993a;Mitchell, Strain, & Blandford, 2007;Murtaugh, McCall, Moore, & Meadow, 2003;Schlenker et al, 2002;Vanderboom & Madigan, 2008).…”

“…Studies examining HH agencies and HH utilization in rural areas found that not only most rural states had fewer HH agencies (Vanderboom & Madigan, 2008) and a disproportionate percentage of rural beneficiaries living in areas with little to no HH service utilization compared to their urban peers (Hartman, Jarosek, Virnig, & Durham, 2007), but also reductions in the HH agency size and number of HH visits per patient as the rurality increased. Evidence also indicates that rural residents are less healthy, receive more direct care from registered nurses (Adams et al, 2001), and less likely to receive therapy services (Chen & Phillips, 1993;Kenney, 1993b;Sutton, 2005a) compared to their urban peers.…”

Recruitment and Retention of Home Support Workers in Rural Communities

“…McAuley, Spector, and Van Nostrand (2009) found that adults living in remote areas received fewer days of home care, suggesting a possible access problem. Vanderboom and Madigan (2008) reported that rural home care and home support agencies provided fewer visits per patient, which they speculate may be linked to the availability of human and financial resources. Forbes and Janzen (2004) found that rural home care and home support users are more likely than their urban counterparts to receive help with housework and less likely to receive help with personal care.…”