RUHHQS
Quality of Home Health Care: A Rural-Urban Comparisons
(Rural-Urban Home Health Quality Study)
Funded by: Agency for Health Care Policy and Research
Project Period: 1993 - 1999
The purpose of this study was to determine whether the effectiveness of home
health care services is inferior in rural areas relative to urban areas, with
effectiveness measured in terms of patient outcomes. The study also included
analyses of factors that might explain rural-urban outcome variation, including
the quantity, mix, and cost of home health services patients receive, use of
other Medicare services, case mix (including demographic and socioeconomic
factors) at home health admission, and other covariates, such as payer and
agency characteristics. The study obtained primary data from national samples
of rural and urban home health agencies and patients, with 72 agencies and
longitudinal data on over 5000 patients. Patients were followed from home
health admission to discharge, hospitalization (or other institutional
admission), or 120 days, with primary data collected at each 60-day interval
between admission and the end of data collection. The primary data were used
to measure case mix and outcomes, and to risk adjust in analyses of outcomes,
utilization, length of stay, and cost. The study also involved extensive
analysis of Medicare claims data on home health and other services, with the
claims data linked for comparable time periods to the primary study data. The
analyses indicate that rural compared to similar (i.e., case mix adjusted)
urban elderly patients receive fewer home health services and appear to achieve
somewhat inferior outcomes, particularly in terms of discharge status.
Key Staff: Schlenker, Powell, Shaughnessy
Journal Articles:
Schlenker RE, Powell MC, Goodrich GK. Rural-Urban Home Health Care Differences Before the Balanced Budget Act of 1997. The Journal of Rural Health, 18(2):359-372, Spring 2002.
Research Monographs:
Powell MC, Hittle DF, Hrincevich CA, Schlenker RE, Shaughnessy PW, Bostrom SG, Beaudry JM. Final Sampling, Data Collection, and Analysis Plans. Study Paper 4. Center for Health Services Research, Denver, CO, 1995.
Powell MC, Tooze J, Schlenker RE, Crisler KS, Shaughnessy PW. Primary Data Measures and Data Items: Outcomes and Related Covariates. Study Paper 5. Center for Health Services Research, Denver, CO, 1995.
Hittle DF, Powell MC, Caminer SJ, Shaughnessy PW. Identifying Providers of Home Health Care to the Rural Population: Definitional and Methodological Issues. Study Paper 7. Center for Health Services Research, Denver, CO, 1995.
Schlenker RE, Powell MC, Bostrom SG, Goodrich GK. Case Mix of Elderly Rural and Urban Home Health Patients: Initial Comparisons, Study Paper 9, September 1998.
Schlenker RE, Powell MC, Kaehny MM, Boyce EJ. Background, Samples, Area and Agency Characteristics, Study Paper 10, November 1998.
Schlenker RE, Powell MC, Goodrich GK, Kaehny MM. Final Report, November 2000.
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