Racial Disparities in Therapy After-Care Compel Action

A new analysis finds that African-Americans were significantly more likely than white patients to be discharged to facilities instead of home care after knee-replacement surgery. This study joins a growing body of scholarship on disparities in post-acute care.

Specifically, an analytic sample of 107,768 patients found that African-Americans were 2.5 to 5 times more likely than white patients to be discharged to an inpatient rehabilitation facility or skilled nursing facility than to their home. The researchers noted the possibility of social determinants of health as a factor in after-care discharge planning, “not only … clinical indications,” noting that future studies are needed.

These findings coincide with research showing that, as a whole, discharges to facilities are decreasing and home care is on the rise for knee or hip-replacement after-care. Also, home care patients in such instances had the same — or better — clinical improvement following joint replacement surgery compared to those who entered a skilled nursing facility, where the costs of care are significantly higher. (HCA reported on this research in the April 2019 edition of the Capitol Report.)

Home care is uniquely positioned to address disparities in race, ethnicity, culture or language, sexual orientation or gender identity, geographic location, or other factors. Home care considers the entirety of a patient’s circumstances, including social determinants of health, in assessing, planning and delivering care. Many of the conditions most prone to disparities — such as diabetes or asthma — are among the top specialty areas of home care.

As reported previously in the Capitol Report, HCA advanced a bill (A.6772/S.4942 of 2019, sponsored by Senator James Sanders, Jr., and Assembly Member Crystal Peoples-Stokes) this past legislative session leveraging home care to address disparities. One factor that many recent studies find in common is the shared responsibility across sectors to address this issue. That responsibility falls on hospital discharge planning operations, physician practices and community-based support organizations that coordinate services or make referrals to other settings, as well as the clinical decision-making and specialized service designs within each setting, working cooperatively.

The federal government is examining this coordination issue, though not specifically through the lens of disparities. In a new rule, the U.S. Centers for Medicare and Medicaid Services is soon requiring hospitals and post-acute settings to share new information with their patients about the quality measures and data applicable to other settings before patients are discharged or referred to those other settings.

A.6772/S.4942 works in this direction, yet more specifically mindful of disparities, by including this focus under the state’s existing Hospital-Home Care-Physician Collaborative Program, which authorizes models of collaboration among hospitals, home care agencies and physicians to improve outcomes — in this case for underserved populations — and reduce health care costs within the state.

We will look to the Senate and Assembly for support of this measure in 2020 as well.