Racial Health Equity in Medicare Home Health Care for Seriously Ill Older Adults- [electronic resource]
Racial Health Equity in Medicare Home Health Care for Seriously Ill Older Adults- [electronic resource]
상세정보
- 자료유형
- 학위논문파일 국외
- 최종처리일시
- 20240214101254
- ISBN
- 9798379782993
- DDC
- 361
- 저자명
- Jones, Tessa.
- 서명/저자
- Racial Health Equity in Medicare Home Health Care for Seriously Ill Older Adults - [electronic resource]
- 발행사항
- [S.l.]: : New York University., 2023
- 발행사항
- Ann Arbor : : ProQuest Dissertations & Theses,, 2023
- 형태사항
- 1 online resource(95 p.)
- 주기사항
- Source: Dissertations Abstracts International, Volume: 85-01, Section: B.
- 주기사항
- Advisor: Padgett, Deborah.
- 학위논문주기
- Thesis (Ph.D.)--New York University, 2023.
- 사용제한주기
- This item must not be sold to any third party vendors.
- 초록/해제
- 요약Medicare Home Health Care (HHC) services are integral to the care of homebound older adults who demonstrate skilled need in the community. HHC is especially important for seriously ill older adults who, as high need high-cost patients, often require ongoing specialized medical care. Health disparities have become a growing public health concern. Although disparities in health care access, quality, and outcomes have been well researched and documented in inpatient and primary care, there has been a lag in the development of research examining disparities experienced by historically marginalized racial and ethnic groups receiving HHC. Using a three-paper dissertation format, three interrelated studies examined the relationship between race and ethnicity of seriously ill HHC beneficiaries and 1) health outcomes (Study 1); 2) agency quality (Study 2) and; 3) area-level deprivation and agency quality (Study 3).Study 1: Start of care and discharge data from the 2016 HHC Outcome and Assessment information Set (OASIS) were used to examine the relationship between individual characteristics and differences in HHC health outcomes of Dyspnea, Pain Frequency, Presence of Unhealed Pressure Ulcer Stage II or higher, and Cognitive Functioning for beneficiaries who were seriously ill. A generalized ordered logit model with partial proportional odds was used for the ordinal categorical outcomes and a logistic regression was used for the binary dependent variable. Findings indicated that seriously ill historically marginalized racial and ethnic groups have worse HHC health outcomes compared to non-Hispanic White patients with the exception of pain frequency.Study 2: This study used a fixed effects model wherein the outcome was HHC agency quality (star-rating) with patient-level predictors and Zip code tabulation area (ZCTA) fixed effects. By using ZCTA fixed effects, this paper focused on the effects patient characteristics had on accessing a high-quality HHC agency within a ZCTA. The main findings show that setting all neighborhood (ZCTA) differences aside, Medicare beneficiaries with serious illness receiving HHC in the same neighborhood (ZCTA), are getting different access to high quality care based on identifying as Black or African American or having Medicaid or Private pay as additional payment sources to Medicare. Self-pay as an additional payment source is associated with receiving care from higher quality agencies.Study 3: The relationship between area-level social deprivation and receiving care from a high-quality home health agency was estimated using a linear mixed regression model with ZCTA random effects while controlling for individual-level covariates. The results show that area-level social deprivation has a negative impact on the probability of people receiving care from a high-quality rated agency. The findings also indicate that the impact of race and ethnicity on access to high quality HHC persists regardless of the level of social deprivation in a given neighborhood.The discussion and limitations of this research along with the associated policy implications are covered throughout the three papers and in the dissertation conclusion.
- 일반주제명
- Social work.
- 일반주제명
- Public health.
- 일반주제명
- Health care management.
- 키워드
- Health equity
- 키워드
- Race
- 키워드
- Serious illness
- 키워드
- Pain frequency
- 기타저자
- New York University PhD Program
- 기본자료저록
- Dissertations Abstracts International. 85-01B.
- 기본자료저록
- Dissertation Abstract International
- 전자적 위치 및 접속
- 로그인 후 원문을 볼 수 있습니다.
MARC
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■020 ▼a9798379782993
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■040 ▼aMiAaPQ▼cMiAaPQ
■0820 ▼a361
■1001 ▼aJones, Tessa.
■24510▼aRacial Health Equity in Medicare Home Health Care for Seriously Ill Older Adults▼h[electronic resource]
■260 ▼a[S.l.]:▼bNew York University. ▼c2023
■260 1▼aAnn Arbor :▼bProQuest Dissertations & Theses, ▼c2023
■300 ▼a1 online resource(95 p.)
■500 ▼aSource: Dissertations Abstracts International, Volume: 85-01, Section: B.
■500 ▼aAdvisor: Padgett, Deborah.
■5021 ▼aThesis (Ph.D.)--New York University, 2023.
■506 ▼aThis item must not be sold to any third party vendors.
■520 ▼aMedicare Home Health Care (HHC) services are integral to the care of homebound older adults who demonstrate skilled need in the community. HHC is especially important for seriously ill older adults who, as high need high-cost patients, often require ongoing specialized medical care. Health disparities have become a growing public health concern. Although disparities in health care access, quality, and outcomes have been well researched and documented in inpatient and primary care, there has been a lag in the development of research examining disparities experienced by historically marginalized racial and ethnic groups receiving HHC. Using a three-paper dissertation format, three interrelated studies examined the relationship between race and ethnicity of seriously ill HHC beneficiaries and 1) health outcomes (Study 1); 2) agency quality (Study 2) and; 3) area-level deprivation and agency quality (Study 3).Study 1: Start of care and discharge data from the 2016 HHC Outcome and Assessment information Set (OASIS) were used to examine the relationship between individual characteristics and differences in HHC health outcomes of Dyspnea, Pain Frequency, Presence of Unhealed Pressure Ulcer Stage II or higher, and Cognitive Functioning for beneficiaries who were seriously ill. A generalized ordered logit model with partial proportional odds was used for the ordinal categorical outcomes and a logistic regression was used for the binary dependent variable. Findings indicated that seriously ill historically marginalized racial and ethnic groups have worse HHC health outcomes compared to non-Hispanic White patients with the exception of pain frequency.Study 2: This study used a fixed effects model wherein the outcome was HHC agency quality (star-rating) with patient-level predictors and Zip code tabulation area (ZCTA) fixed effects. By using ZCTA fixed effects, this paper focused on the effects patient characteristics had on accessing a high-quality HHC agency within a ZCTA. The main findings show that setting all neighborhood (ZCTA) differences aside, Medicare beneficiaries with serious illness receiving HHC in the same neighborhood (ZCTA), are getting different access to high quality care based on identifying as Black or African American or having Medicaid or Private pay as additional payment sources to Medicare. Self-pay as an additional payment source is associated with receiving care from higher quality agencies.Study 3: The relationship between area-level social deprivation and receiving care from a high-quality home health agency was estimated using a linear mixed regression model with ZCTA random effects while controlling for individual-level covariates. The results show that area-level social deprivation has a negative impact on the probability of people receiving care from a high-quality rated agency. The findings also indicate that the impact of race and ethnicity on access to high quality HHC persists regardless of the level of social deprivation in a given neighborhood.The discussion and limitations of this research along with the associated policy implications are covered throughout the three papers and in the dissertation conclusion.
■590 ▼aSchool code: 0146.
■650 4▼aSocial work.
■650 4▼aPublic health.
■650 4▼aHealth care management.
■653 ▼aHealth disparities
■653 ▼aHealth equity
■653 ▼aRace
■653 ▼aSerious illness
■653 ▼aPain frequency
■690 ▼a0452
■690 ▼a0769
■690 ▼a0573
■71020▼aNew York University▼bPh.D. Program.
■7730 ▼tDissertations Abstracts International▼g85-01B.
■773 ▼tDissertation Abstract International
■790 ▼a0146
■791 ▼aPh.D.
■792 ▼a2023
■793 ▼aEnglish
■85640▼uhttp://www.riss.kr/pdu/ddodLink.do?id=T16933501▼nKERIS▼z이 자료의 원문은 한국교육학술정보원에서 제공합니다.
■980 ▼a202402▼f2024
