| Autor: |
Quigley, Denise D., Chastain, Ashley M., Kang, Jung A., Bronstein, David, Dick, Andrew W., Stone, Patricia W., Shang, Jingjing |
| Jazyk: |
angličtina |
| Rok vydání: |
2022 |
| Předmět: |
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| Zdroj: |
J Am Med Dir Assoc |
| Popis: |
OBJECTIVE. Home healthcare agencies (HHAs) are skilled care providers for Medicare home health beneficiaries in the United States. Rural HHAs face different challenges than their urban counterparts in delivering care, e.g., longer distances to travel to patient homes leading to higher fuel/travel costs and fewer number of visits in a day, impacting the quality of home healthcare for rural beneficiaries. We review evidence on differences in care outcomes provided by urban and rural HHAs. DESIGN. Systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using the Newcastle-Ottawa Scale (NOS) for quality appraisal. SETTING. Care provided by urban and rural HHAs. METHODS. We conducted a systematic search for English-language peer-reviewed articles after 2010 on differences in urban and rural care provided by U.S. HHAs. We screened 876 studies, conducted full-text abstraction and NOS quality review on 36 articles and excluded two for poor study quality. RESULTS. Twelve studies were included; 7 focused on patient-level analyses and 5 were HHA-level. Nine studies were cross-sectional and 3 used cohorts. Urban and rural differences were measured primarily using a binary variable. All studies controlled for agency-level characteristics, and two-thirds also controlled for patient characteristics. Rural beneficiaries, compared to urban, had lower home healthcare utilization (4 of 5 studies) and fewer visits for physical therapy and/or rehabilitation (3 of 5 studies). Rural agencies had lower quality of HHA services (3 of 4 studies). Rural patients, compared to urban, visited the emergency room more often (2 of 2 studies) and were more likely to be hospitalized (2 of 2 studies), whereas urban heart failure patients were more likely to have 30-day preventable hospitalizations (1 study). CONCLUSION AND IMPLICATIONS. This review highlights similar urban/rural disparities in home healthcare quality and utilization as identified in previous decades. Variables used to measure the access to and quality of care by HHAs varied so consensus was limited. Articles that utilized more granular measures of rurality (rather than binary measures) revealed additional differences. These findings point to the need for consistent and refined measures of rurality in studies examining urban and rural differences in care from HHAs. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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