# Disparities in Access to High-Quality Home Health and the Impact of Public Reporting

> **NIH NIH R36** · BROWN UNIVERSITY · 2020 · $53,379

## Abstract

PROJECT SUMMARY
Although the Centers for Medicare and Medicaid Services (CMS) spends over $18 billion annually to care for
approximately 3.4 million home health (HH) beneficiaries, little is known about access to HH for vulnerable
populations (i.e., racial/ethnic minorities, low-income older adults, and older adults living in high minority and/or
high poverty neighborhoods.) Prior research shows that lower quality home health agencies (HHAs) have higher
proportions of minorities, low-income older adults, and beneficiaries from low-income neighborhoods. Reasons
for these findings are not well understood, but they may be associated with disparate availability of high-quality
HH for underserved populations. Additionally, there is limited information about whether or not current public
reporting strategies (i.e., HHCompare Five-Star Ratings) have impacted access to HH or exacerbated disparities
in access to HH. The long-term goal of this research is to ensure access to high-quality long-term services and
supports for older adults in order to improve older adults' quality of life and care, regardless of individual- and
neighborhood-level attributes. The first step towards this goal, and the overall objective of this application is to
use national administrative datasets (e.g., standardized HH patient assessment data) to analyze differences in
access to high-quality HH care for vulnerable older adults and to understand if and how public reporting
influences patients' access to high-quality services. The central hypotheses are that low-income and racial/ethnic
minority older adults, as well as beneficiaries living in vulnerable neighborhoods, are more likely to have lower
access to high-quality HHAs as compared to their white, more affluent counterparts; and that HHCompare Five-
Star ratings will negatively impact access for these underserved populations. To evaluate these hypotheses, the
following specific aims are proposed: 1) Assess the impact of individual- and neighborhood-level factors on the
utilization of high-quality HHAs among older racial/ethnic minorities and low-income older adults; and 2) Evaluate
the differential impact of the HHCompare Five-Star ratings on the utilization of high-quality HHAs for vulnerable
populations. To achieve these objectives, this study examines the national population of Medicare beneficiaries
receiving HH care between 2012 and 2017 using enrollment, HH Outcome and Assessment Information Set
(OASIS), HHCompare, and Census data. The proposed work is innovative because 1) few studies examine HH
disparities, 2) this is the first study to examine HHA and patient response to public reporting of quality summary
measures, 3) it will link several national data sources, and 4) it will utilize models that jointly consider the relative
influence of individual- and neighborhood-level effects. This work is significant because understanding within-
(individual-level) and across-neighborhood disparities in access to high-quality...

## Key facts

- **NIH application ID:** 10041137
- **Project number:** 1R36AG068199-01
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Shekinah Antoinette Fashaw-Walters
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $53,379
- **Award type:** 1
- **Project period:** 2020-09-15 → 2021-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10041137

## Citation

> US National Institutes of Health, RePORTER application 10041137, Disparities in Access to High-Quality Home Health and the Impact of Public Reporting (1R36AG068199-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10041137. Licensed CC0.

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