Sasha M. Vergez, Yolanda Barrón, Margaret V. McDonald
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The objective of this study was to assess if there were associations between neighborhood disadvantage and delayed start-of-care (SOC) HHC visits.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We conducted a retrospective observational study on newly admitted HHC patients after a hospital discharge during the years 2021 and 2022. The total sample included 73,536 HHC episodes of care. We used log-binomial regressions to examine the association between a delayed SOC HHC visit, defined as a first HHC visit occurring after 48 h of hospital discharge, and neighborhood disadvantage, adjusting for patients' age, race, sex, and clinical status.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Close to one-third (23,712; 32.3%) of HHC episodes experienced a delayed SOC HHC visit. As the level of neighborhood disadvantage increased, so did the risk of experiencing delayed care. After adjusting for covariates, patients living in the most disadvantaged neighborhoods (level 5) had a 13% (RR 1.13; 95% CI 1.10–1.17) higher risk of experiencing delayed care when compared to those in the least disadvantaged neighborhoods (level 1). As the level of neighborhood disadvantage increased, so did the proportion of minority patients.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>These findings underscore the disparities in receipt of timely HHC among differing levels of neighborhood disadvantage. 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引用次数: 0
摘要
背景：研究表明，延迟接受家庭医疗保健（HHC）与患者的负面结果（如住院、急诊就诊和死亡）有关。研究着眼于导致延误的因素，包括高失业率地区和患者的种族/民族背景。然而，之前没有研究调查过城市中不同程度的社区弱势群体提供的及时护理是如何不同的。本研究的目的是评估社区劣势与延迟开始护理（SOC） HHC就诊之间是否存在关联。方法：我们对2021年和2022年新入院的HHC出院患者进行回顾性观察研究。总样本包括73,536例HHC发作。我们使用对数二项回归来检验延迟SOC HHC就诊（定义为出院48小时后首次HHC就诊）与社区不利因素之间的关系，调整了患者的年龄、种族、性别和临床状况。结果：接近三分之一(23,712；32.3%)的HHC发作经历了延迟的SOC HHC就诊。随着社区弱势水平的增加，经历延迟护理的风险也在增加。在调整协变量后，生活在最弱势社区的患者（水平5）的风险为13% (RR 1.13；95% CI 1.10-1.17)与最弱势社区的患者相比，经历延迟护理的风险更高（水平1）。随着社区弱势水平的增加，少数民族患者的比例也在增加。结论：这些发现强调了不同社区弱势群体在及时接受HHC方面的差异。由于HHC被认为是一种比机构急症后护理更安全、更舒适的替代方案，确保可获得和公平的护理对于维持高质量的护理至关重要，特别是对已经边缘化的人群。
Disparities in Timely Receipt of Home Healthcare: Neighborhood Disadvantage and Delayed Start-of-Care Visits in New York City
Background
Research has shown that delayed receipt of home healthcare (HHC) is linked to negative patients' outcomes such as hospitalizations, emergency department visits, and death. Studies have looked at factors contributing to delays including high-unemployment areas and racial/ethnic backgrounds of patients. However, no previous study had examined how the deliverance of timely care differs among levels of neighborhood disadvantage within an urban city. The objective of this study was to assess if there were associations between neighborhood disadvantage and delayed start-of-care (SOC) HHC visits.
Methods
We conducted a retrospective observational study on newly admitted HHC patients after a hospital discharge during the years 2021 and 2022. The total sample included 73,536 HHC episodes of care. We used log-binomial regressions to examine the association between a delayed SOC HHC visit, defined as a first HHC visit occurring after 48 h of hospital discharge, and neighborhood disadvantage, adjusting for patients' age, race, sex, and clinical status.
Results
Close to one-third (23,712; 32.3%) of HHC episodes experienced a delayed SOC HHC visit. As the level of neighborhood disadvantage increased, so did the risk of experiencing delayed care. After adjusting for covariates, patients living in the most disadvantaged neighborhoods (level 5) had a 13% (RR 1.13; 95% CI 1.10–1.17) higher risk of experiencing delayed care when compared to those in the least disadvantaged neighborhoods (level 1). As the level of neighborhood disadvantage increased, so did the proportion of minority patients.
Conclusions
These findings underscore the disparities in receipt of timely HHC among differing levels of neighborhood disadvantage. As HHC is presented as a safer and more comfortable alternative to institutional post-acute care, ensuring the availability and equitable care is essential for maintaining high-quality care especially for already marginalized populations.
期刊介绍：
Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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