The Importance of Quality of Home Health Agencies for Patients in Socioeconomically Disadvantaged Neighborhoods.

Objectives: This study investigated the role of patients' neighborhood socioeconomic status (SES) on the relationship between home health agency (HHA) care quality and health outcomes among home health care patients.

Design: Retrospective cohort study.

Setting and participants: We mainly used 2019 Outcome and Assessment Information Set data, Area Deprivation Index, and Quality of Patient Care Star Rating. We included Medicare beneficiaries (aged ≥ 65 years) who received home health care.

Methods: We used linear probability regression models to examine whether patients' neighborhood SES moderates the association between care quality of HHAs and health outcomes for 1,657,133 home health care patients.

Results: Our findings show that patients in neighborhoods with lower SES were more likely to use low-quality HHAs (lease disadvantaged neighborhoods: 11%, most disadvantaged neighborhoods: 15.2%). Our main model, adjusted by patient- and HHA-level characteristics, reveals patients living in socioeconomically disadvantaged neighborhoods (less disadvantaged: coefficient: -0.017, P < .001; more disadvantaged: coefficient: -0.035, P < .001; most disadvantaged: coefficient: -0.06, P < .001) and receiving care from low-quality HHAs (average-quality HHAs: coefficient: 0.037, P < .001; high-quality HHAs: coefficient: 0.062, P < .001) were less likely to remain in the community during their home health care. Furthermore, our study highlights that patients in the most disadvantaged neighborhoods encounter additional challenges in remaining at their homes and communities when they use low-quality HHAs.

Conclusions and implications: These findings highlight the need for targeted interventions and policy initiatives aimed at addressing disparities in care quality based on neighborhood SES. Efforts directed at enhancing the quality of care provided by HHAs and access to high-quality HHAs in socioeconomically disadvantaged neighborhoods could substantially impact health equity and outcomes for individuals in these settings.