摘要
【ABSTRACT】【Background】Research has shown that delayed receipt of home healthcare (HHC) is linked to negative patients' outcomes such as hospitalizations, emergency department visits, and death. Studies have looked at factors contributing to delays including high‐unemployment areas and racial/ethnic backgrounds of patients. However, no previous study had examined how the deliverance of timely care differs among levels of neighborhood disadvantage within an urban city. The objective of this study was to assess if there were associations between neighborhood disadvantage and delayed start‐of‐care (SOC) HHC visits.【Methods】We conducted a retrospective observational study on newly admitted HHC patients after a hospital discharge during the years 2021 and 2022. The total sample included 73,536 HHC episodes of care. We used log‐binomial regressions to examine the association between a delayed SOC HHC visit, defined as a first HHC visit occurring after 48 h of hospital discharge, and neighborhood disadvantage, adjusting for patients' age, race, sex, and clinical status.【Results】Close to one‐third (23,712; 32.3%) of HHC episodes experienced a delayed SOC HHC visit. As the level of neighborhood disadvantage increased, so did the risk of experiencing delayed care. After adjusting for covariates, patients living in the most disadvantaged neighborhoods (level 5) had a 13% (RR 1.13; 95% CI 1.10–1.17) higher risk of experiencing delayed care when compared to those in the least disadvantaged neighborhoods (level 1). As the level of neighborhood disadvantage increased, so did the proportion of minority patients.【Conclusions】These findings underscore the disparities in receipt of timely HHC among differing levels of neighborhood disadvantage. As HHC is presented as a safer and more comfortable alternative to institutional post‐acute care, ensuring the availability and equitable care is essential for maintaining high‐quality care especially for already marginalized populations.
摘要译文
【摘要】【背景】研究表明，延迟收到家庭医疗保健（HHC）与患者的负面结果（例如住院，急诊就诊和死亡）有关。研究研究了导致延误的因素，包括高农业领域和患者的种族/种族背景。但是，以前没有研究过及时的护理在城市城市内部的不利地位之间的及时护理范围有何不同。这项研究的目的是评估邻里劣势与延迟的起步（SOC）HHC访问之间是否存在关联。我们使用对数临界回归进行检查，以检查SOC HHC访问延迟的延迟访问之间的关联，该访问定义为住院48小时后发生的第一次HHC访问，以及邻里的劣势，调整患者的年龄，种族，性别，性别和临床状态。随着社区劣势水平的提高，经历延迟护理的风险也是如此。调整了协变量后，与最少弱势群落的社区相比，在最不利的社区中的患者（5级）的患者（RR 1.13; 95％CI 1.10–1.17）的延迟护理风险更高（1级）。随着邻里劣势水平的提高，少数族裔患者的比例也随之增加。由于HHC被作为机构后护理的更安全，更舒适的替代品，因此确保可用性和公平护理对于维持高质量的护理至关重要，尤其是对于已经边缘化的人群而言。
Sasha M. Vergez (https://orcid.org/0000-0003-4733-7180) [1];Yolanda Barrón [2];Margaret V. McDonald [3];. Disparities in Timely Receipt of Home Healthcare: Neighborhood Disadvantage and Delayed Start‐of‐Care Visits in New York City[J]. Journal of the American Geriatrics Society, 2025,73(5): 1462-1471