The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #65329

Karen Peters, DrPH, Rural Health Professions, University of Illinois at Chicago College of Medicine, 1601 Parkview, Rockford, IL 61107, 815/395-5906, kpeters@uic.edu

A multilevel theoretical and analytical approach was used to examine average length of stay patterns among providers of home health care. Cross sectional data were analyzed on approximately 755 home health agencies (15% non-metropolitan) and their clients using baseline information from the National Home Health and Hospice Care Survey. Relationships between agency and client level variables were examined to explore the relative influences of each on length of stay (LOS) in home health care in rural and metropolitan areas. Significant variation in LOS was observed in the rural and urban comparisons with longer average LOS observed in agencies located in rural areas (p <.01). Models were developed and tested that included variables thought to be mutable to organizational interventions while controlling for patient characteristics. Nearly 20% of the variance in the entire sample can be explained by organizational level characteristics. In addition, significant differences were found in payment mechanisms and diagnostic information at the patient level. Further, in multivariate, random effects analysis, it was found that LOS is shorter in for profit agencies and among those using fewer providers but these patterns change according to geographic location of the agency. Therefore, if reduced LOS is a policy goal for home health care, changes in the practices of providers might be a useful strategy. However, attention must be paid to the staffing patterns in home health care, particularly in rural agencies, before such a strategy is implemented due to the potential for reduced quality of care in already underserved areas.

Learning Objectives:

• At the conclusion of the session, the participant (learner) in this session will be able to:
• Identify organizational and patient factors that are important to predicting length of stay in home health care
• Discuss the importance of geographic location (i.e. rural vs. urban) in predicting length of stay in home health care
• Evaluate the utility of using a multilevel theoretical and analytical approach to the study of home health care as a community-based health service delivery mechanism.

Keywords: Home Care, Rural Populations

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.