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

Autor:	Bigger SE; East Tennessee State University, Johnson City, TN, USA., Hemphill JC; East Tennessee State University, Johnson City, TN, USA., Njoroge T; University of Texas at Arlington, Arlington, TX, USA., Doyon K; Boise State University, Boise, ID, USA., Glenn L; GMX Analytics, Kingsport, TN, USA.
Jazyk:	angličtina
Zdroj:	The American journal of hospice & palliative care [Am J Hosp Palliat Care] 2024 Feb; Vol. 41 (2), pp. 140-149. Date of Electronic Publication: 2023 May 16.
DOI:	10.1177/10499091231176281
Abstrakt:	Skilled home health (HH) is the largest long-term care setting and the fastest-growing site of healthcare in the United States (U.S.). Home Health Value-Based Purchasing (HHVBP) is a structure of Medicare that penalizes U.S. HH agencies for high hospitalization rates. Prior studies have shown inconsistent evidence about associations of race with hospitalization rates in HH. Evidence supports that Black or African Americans are less likely to participate in advance care planning (ACP), or to complete written advance directives, which could affect their potential for hospitalization when nearing end of life. In this quasi-experimental study, we used Medicare administrative datasets, the Weighted Acute Care Services Use Rates (WACSUR) score, and the Advance Care Planning Protocol (ACPP) score to determine whether the proportion of Black HH patients in the U.S. was correlated with acute care use rates and the robustness of agency protocols on ACP. We used primary and secondary data from the U.S. from 2016-2020. We included Medicare-certified HH agencies. Spearman's correlation coefficient was used. We found a statistical trend showing that the greater proportion of Black patients enrolled in a HH agency, the greater tendency to have a high hospitalization rate. Our findings suggest that HHVBP may encourage patient selection and exacerbate health disparities. Our findings support recommendations for alternative measures of quality in HH to include measures of goal-concordant care coordination when patients are denied admission to HH. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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