Disparities in Timely Access to Postoperative Home Health Care and Functional Recovery After Joint Replacement by...

Area of Science:

• Gerontology
• Health Services Research
• Orthopedic Surgery

Background:

• Hip and knee replacements are common procedures for elderly Medicare beneficiaries.
• Timely initiation of home health (HH) care is crucial for post-operative recovery and functional outcomes.
• Dual-eligible (DE) status and rural residence may present barriers to accessing timely HH services.

Purpose of the Study:

• To investigate the association between DE status, rural residence, and timely HH initiation after hip or knee replacement.
• To examine the impact of DE status and rural residence on physical function recovery in HH patients.

Main Methods:

• Retrospective cohort study using national Medicare claims data (2021-2023).
• Included 18,998 beneficiaries aged ≥65 undergoing hip or knee replacement and discharged to HH.
• Analyzed timely HH initiation (within 2 days) and mobility improvement, comparing rural vs. urban and DE vs. non-DE beneficiaries.

Main Results:

• 17% of patients experienced delayed HH initiation.
• Rural and DE beneficiaries had significantly lower odds of timely HH initiation (ORs 0.84 and 0.80, respectively).
• Rural and DE beneficiaries also showed lower odds of mobility improvement (ORs 0.80 and 0.68, respectively).

Conclusions:

• Rural and DE Medicare beneficiaries experience significant disparities in timely HH initiation and functional recovery post-hip or knee replacement.
• These findings highlight the need for targeted quality improvement initiatives to address access and timeliness of HH care for underserved populations.
• Strategies should focus on improving HH service delivery for rural and dual-eligible Medicare beneficiaries.