Race and Ethnicity Are Related to Undesirable Home Health Care Outcomes in Seriously Ill Older Adults.
Tessa Jones, Elizabeth A Luth, Charles M Cleland and 1 others
PMID 38604244WHAT IT FOUND
Serious illness home health outcomes were not equal across race and ethnicity.
Black, Hispanic, and American Indian/Alaskan Native patients had worse breathing or cognition, and Hispanic patients with an existing ulcer were more likely to leave with it. Review referral and support needs.
Key findings
01Hispanic beneficiaries had 14–39% higher odds of poor dyspnea outcomes at discharge than non-Hispanic White beneficiaries; higher dyspnea was also associated with American Indian or Alaskan Native and Black race.
02At discharge, Black patients had 8–39% higher odds of worsening cognitive functioning and Hispanic or Latino patients had 20–56% higher odds than White patients.
03Hispanic patients who started care with an unhealed stage 2 or higher pressure ulcer had odds ratio 1.45 of still having one at discharge relative to White patients; Asian patients without one at start had odds ratio 0.39.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was an observational records analysis, so it cannot show that race caused worse outcomes or that any home health intervention improved them. It excluded patients who transferred to hospital or died, so it says nothing about seriously ill patients who did not remain at home. The OASIS assessments may under-report symptoms for some groups because of mistrust, language differences, cultural stigma, or clinician bias. Asian patients' lower reported pain may reflect less reporting rather than truly less pain. Race and ethnicity categories were limited and did not capture multiracial or more specific identities. The analysis did not include agency quality, referral patterns, time to care initiation, or area-level social deprivation, so it cannot identify the upstream causes of the differences.
Declared interests
The supplied text does not include a conflict-of-interest declaration. The publication types note NIH extramural research support.
The easy way to misread this
Do not conclude that home health therapists caused these differences or that a specific therapy will reduce them. The study was observational and did not test treatments; some findings, such as lower reported pain for Asian patients, may reflect under-reporting rather than truly less pain.