作者：NursingResearch護理研究前
分享智慧 共同成長
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Rural home healthcare agencies perform better on process measures，urban agencies on outcome measures
The quality of home healthcare varies by location，with rural home healthcare agencies initiating care more quickly while urban agencies excel in preventing hospitalizations，according to a new study by researchers at NYU Rory Meyers College of Nursing. The findings are published in the Journal of Rural Health.
Home healthcare—in which healthcare providers，primarily nurses，visit patients’ homes to deliver care—is one of the fastest growing healthcare sectors in the United States. In 2018，more than 5 million Medicare beneficiaries received home healthcare; 9 percent of patients lived in rural areas.
As the use of home healthcare increases across the country，researchers are working to better understand how quality varies and whether there are disparities in care based on location. To understand differences between quality in urban and rural home healthcare，the researchers analyzed national data on home health quality performance measures from the Centers for Medicare and Medicaid Services over five years (2014 to 2018). Their data included 7,908 home health agencies，of which nearly 20 percent (1,537) were in rural areas. Quality performance measures included timely initiation of care (a measure of care process)，and hospitalization and emergency department visits (two measures of care outcomes).
The researchers measured numerous differences between urban and rural agencies，both at individual time points and over time，with rural agencies performing better on the care process measure and urban agencies performing better on the outcome measures. Rural agencies consistently initiated care in a timely fashion，meaning that they quickly started home care upon a doctor’s orders or within two days of hospital discharge or referral to home care.
『Providing early，intensive visits to patients during a home health episode has been shown to be effective in reducing hospitalization and improving functional status，so timely initiation of care is a critical component of quality home care for patients,』 said Chenjuan Ma，PhD，MSN，an assistant professor at NYU Meyers and the study’s lead author. 『Strong relationships between rural home health agencies and local hospitals，as evidenced in previous research，may be facilitating the timely initiation of home healthcare to rural patients.』
In contrast，urban agencies consistently performed better on preventing hospitalization and emergency room visits during home care over time—although，notably，emergency department visits increased over the five years studied for both urban and rural home health agencies. These gaps between rural and urban agencies were steady over time except the gap in hospitalization，which narrowed slightly over time.
『Our study highlights the persistence of disparities in quality of home healthcare. Limited improvements have been made in the quality of home healthcare over time，and the gaps in quality of care did not significantly shrink between rural and urban agencies,』 added Ma.
The researchers stress the importance of reducing rural-urban disparities by taking into account the unique geographic，staffing，and health challenges facing agencies. For instance，in addition to staffing and resource challenges，providers from rural home health agencies often spend a significant amount of time traveling to and from patient homes，which could result in less efficient care delivery and could ultimately influence outcomes. In addition，reports on rural and urban recipients of home healthcare suggest that rural patients are in poorer overall health status than their urban counterparts.
Additional study authors include Andrea Devoti of the National Association for Home Care & Hospice and Melissa O’Connor of the Villanova University M. Louise Fitzpatrick College of Nursing.
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根據紐約大學羅裡邁耶斯護理學院研究人員的一項新研究，家庭醫療保健的質量因地點而異，農村家庭醫療保健機構啟動護理的速度更快，而城市機構在預防住院方面表現出色。
研究結果 發表在 『農村衛生雜志』上。
家庭醫療保健——醫療保健提供者，主要是護士，到患者家中提供護理——是美國發展最快的醫療保健行業之一。
2018 年，超過 500 萬醫療保險受益人接受了家庭醫療保健；9% 的患者生活在農村地區。
隨著全國范圍內家庭醫療保健使用的增加，研究人員正在努力更好地了解質量如何變化以及是否存在基於位置的護理差異。
為了了解城市和農村家庭醫療保健質量之間的差異，研究人員分析了來自醫療保險和醫療補助服務中心五年《2014 年至 2018 年》的家庭健康質量績效指標的全國數據。
他們的數據包括 7,908 個家庭衛生機構，其中近 20%《1,537 個》位於農村地區。
質量績效衡量指標包括及時啟動護理《衡量護理過程》以及住院和急診就診《衡量護理結果的兩種衡量標準》。
研究人員測量了城市和農村機構之間的許多差異，無論是在個別時間點還是隨著時間的推移，農村機構在護理過程測量方面表現更好，而城市機構在結果測量方面表現更好。
農村機構始終如一地及時啟動護理，這意味著他們根據醫生的命令或在出院或轉診到家庭護理的兩天內迅速開始家庭護理。
『在家庭健康事件期間對患者提供早期、密集的訪問已被證明可有效減少住院和改善功能狀態，因此及時開始護理是為患者提供優質家庭護理的關鍵組成部分，』 Chenjuan Ma 博士說， MSN是紐約大學邁耶斯分校的助理教授，也是該研究的主要作者。
『正如先前的研究所證明的那樣，農村家庭保健機構與當地醫院之間的牢固關系可能有助於及時向農村患者啟動家庭保健』
相比之下，隨著時間的推移，城市機構在預防家庭護理期間住院和急診就診方面始終表現更好——盡管值得注意的是，在研究的五年中，城市和農村家庭衛生機構的急診就診次數都有所增加。
這些農村和城市機構之間的差距隨著時間的推移是穩定的，除了住院方面的差距，隨著時間的推移略有縮小。
『我們的研究強調了家庭醫療保健質量差異的持續存在。
隨著時間的推移，家庭醫療保健質量的改善有限，農村和城市機構之間的護理質量差距並沒有顯著縮小，』馬補充道。
研究人員強調了通過考慮機構面臨的獨特地理、人員配備和健康挑戰來縮小城鄉差距的重要性。
例如，除了人員配備和資源方面的挑戰外，農村家庭衛生機構的提供者通常會花費大量時間往返於患者家中，這可能會導致護理效率降低並最終影響結果。
此外，關於農村和城市家庭醫療保健接受者的報告表明，農村患者的整體健康狀況比城市患者差。
其他研究作者包括美國家庭護理與臨終關懷協會的 Andrea Devoti 和維拉諾瓦大學 M. Louise Fitzpatrick 護理學院的 Melissa O’Connor。
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