Black Americans, hospitalization, and advance care planning: Structural vulnerability in Home Health Value-Based...

Area of Science:

• Healthcare disparities
• Geriatric care
• Public health policy

Background:

• Skilled home health (HH) is a major U.S. long-term care setting.
• Medicare's Home Health Value-Based Purchasing (HHVBP) penalizes agencies with high hospitalization rates.
• Existing research on race and hospitalization in HH shows inconsistent findings.

Purpose of the Study:

• To investigate the correlation between the proportion of Black HH patients and acute care use.
• To examine the relationship between Black patient proportion and agency Advance Care Planning Protocol (ACPP) scores.
• To assess the impact of HHVBP on healthcare disparities.

Main Methods:

• Quasi-experimental study using Medicare administrative datasets (2016-2020).
• Utilized Weighted Acute Care Services Use Rates (WACSUR) and ACPP scores.
• Employed Spearman's correlation coefficient to analyze data from Medicare-certified HH agencies.

Main Results:

• A statistical trend indicated that a greater proportion of Black patients in HH agencies was associated with higher hospitalization rates.
• No specific results on ACPP scores were detailed in the abstract.
• Findings suggest HHVBP may influence patient selection, potentially worsening health disparities.

Conclusions:

• The findings highlight a concerning trend linking higher Black patient enrollment in HH agencies to increased hospitalizations.
• HHVBP policies may inadvertently exacerbate existing health disparities.
• Recommendations include developing alternative quality measures for HH, focusing on goal-concordant care coordination for denied admissions.