Location Factors Heavily into the Quality of Home Health Services Patients Receive

When it comes to home health, location factors heavily into the quality of care patients receive.

Agencies in rural areas tend to initiate care more quickly, for example, while their urban counterparts perform better on outcomes measures, a new study suggests.

The study was conducted by researchers at NYU Rory Meyers College of Nursing. Their findings were published Thursday in the Journal of Rural Health.


In order to examine how quality varies between rural and urban home health settings, the researchers analyzed national data, spanning from 2014 to 2018, on quality performance measures from the U.S. Centers for Medicare & Medicaid Services (CMS). This data included 7,908 home health agencies.

Overall, rural agencies outperform on timely initiation of care. Specifically, these providers began care shortly after doctor’s orders, or within two days after a home health referral or hospital discharge.

On the flip side, urban agencies outperform on preventing hospitalization and emergency room visits.


Still, the study found that emergency department visits increased over the five years studied for agencies in both settings.

There are several factors that may contribute to the quality disparities at rural and urban agencies, according to Chenjuan Ma, an assistant professor at NYU Meyers and the study’s lead author.

“Agencies may be choosing different strategies, given the resources they have and the care or client population they are facing,” she told Home Health Care News. “Rural home health agencies and hospitals also have stronger relationships. That’s going to improve the referral process and help initiate care faster.”

Indeed, the study found that rural agencies were less likely to be for-profit and accredited, and more likely to be hospital-based. These agencies also usually had hospice programs and served both Medicaid and Medicare beneficiaries.

The study also suggests that urban agencies may be more successful in terms of outcomes due to the staffing issues at rural agencies. Rural agencies tend to rely on contracted nurses and therapists to deliver care. Care facilities that have more contracted nurses have a higher chance of poorer patient outcomes, the study notes.

Plus, staff at rural agencies usually spend more time traveling to patients’ homes compared to their counterparts at urban agencies. These working conditions likely play a role in the efficiency of care delivery – and they ultimately impact outcomes.

Additionally, existing health disparities and social factors may also play a role in the study’s findings. Higher rates of cigarette smoking and high blood pressure are seen in rural areas. These areas also tend to have less access to health care and higher rates of poverty, according to the study.

The study advises policymakers to consider the distinctive challenges rural and urban agencies face when it comes time to create policies that aim to improve the quality of home health.

Ma believes that agencies working in these settings can also learn from each other.

“There should be more communication and understanding of each other’s strategy, in order to figure out what really works,” she said.

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