title: Poorer Quality Outcomes of Medicare-Certified Home Health Care in Areas With High Levels of Native American/Alaska Native Residents.
abstract: OBJECTIVE
  Compared with most other groups, many Native Americans or Alaska Natives (NA/AN) individuals are concentrated in rural areas, which typically have lower health service availability. We examined whether quality indicators reported to the Centers for Medicare and Medicaid Services (CMS) by Medicare-certified home health care agencies are equal in areas with high NA/AN concentration.
  
  
  METHODS
  We conducted a cross-sectional analysis. The unit of analysis was the ZIP Code Tabulation Area (N = 32,239). The independent variable was NA/AN concentration at/above 4.2% (95th percentile). Dependent variables included risk-adjusted patient self-care quality measures.
  
  
  RESULTS
  Areas with high levels of NA/AN residents had poorer quality outcomes across both utilization (e.g., hospital admission) and improvement measures (e.g., walking, bathing), for 9 of 12 risk-adjusted patient self-care quality measures.
  
  
  CONCLUSIONS
  Identifying gaps in quality among multiple measures of home health care for high-risk areas allows practitioners and home health care service providers to target quality improvement interventions.
authors.affiliation: Texas A&M Health Science Center, College Station, USA towne@sph.tamhsc.edu.
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Towne
authors.affiliation: University of South Carolina, Columbia, USA.
authors.forename: Janice C
authors.initials: JC
authors.lastname: Probst
authors.affiliation: University of Houston-Clear Lake, TX, USA.
authors.forename: Jordan
authors.initials: J
authors.lastname: Mitchell
authors.affiliation: University of South Carolina, Columbia, USA.
authors.forename: Zhimin
authors.initials: Z
authors.lastname: Chen
mesh_terms: D000368:Aged; D000413:Alaska; D002568:Certification; D003430:Cross-Sectional Studies; D003710:Demography / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006699:Home Care Services / Q000592:standards*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D004930:Inuit / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012424:Rural Population / Q000706:statistics & numerical data*; D012648:Self Care / Q000592:standards; D014481:United States
keywords: Native American; health disparities; health policy; home health care; quality; rural