Racial and Ethnic Disparities in Home Health Referral Among Adult Medicare Patients

Abstract

Background: Home health care (HHC) services following hospital discharge provide essential continuity of care to mitigate risks of posthospitalization adverse outcomes and readmissions, yet patients from racial and ethnic minority groups are less likely to receive HHC visits. Objective: To examine how the association of nurse assessments of patients’ readiness for discharge with referral to HHC services at the time of hospital discharge differs by race and ethnic minority group. Research Design: Secondary data analysis from a multisite study of the implementation of discharge readiness assessments in 31 US hospitals (READI Randomized Clinical Trial: 09/15/2014–03/31/2017), using linear and logistic models adjusted for patient demographic/clinical characteristics and hospital fixed effects. Subjects: All Medicare patients in the study’s intervention arm (n=14,684). Measures: Patient’s race/ethnicity and discharge disposition code for referral to HHC (vs. home) from electronic health records. Patient’s Readiness for Hospital Discharge Scale (RHDS) score (0–10 scale) assessed by the discharging nurse on the day of discharge. Results: Adjusted RHDS scores were similar for non-Hispanic White (8.21; 95% CI: 8.18–8.24), non-Hispanic Black (8.20; 95% CI: 8.12–8.28), Hispanic (7.92; 95% CI: 7.81–8.02), and other race/ethnicity patients (8.09; 95% CI: 8.01–8.17). Non-Hispanic Black patients with low RHDS scores (6 or less) were less likely than non-Hispanic White patients to be discharged with an HHC referral (Black: 26.8%, 95% CI: 23.3–30.3; White: 32.6%, 95% CI: 31.1–34.1). Conclusions: Despite similar RHDS scores, Black patients were less likely to be discharged with HHC. A better understanding of root causes is needed to address systemic structural injustice in health care settings.