The home health prospective payment system (PPS) resulted in major changes in patterns of utilization of home care services. There is some evidence to suggest that some of the post-PPS changes in utilization could compromise quality of care. Prior to this study, there was little empirical information to assess the quality of home care services and how it varies by rural and urban location.

This study was conducted to determine whether rural and urban home care agencies differ in terms of patient care outcomes, and to ascertain whether there are agency characteristics that are associated with better or worse outcomes. The study found rather small differences in the quality of care provided by home health agencies in rural and urban areas. Findings from the multivariate analyses indicated that rural agencies performed better on measures of improvement in walking, transferring, and dressing, whereas urban agencies performed better on measures of improvement in pain frequency and medication management. Rural or urban location had only a modest effect on functional performance scores. Rural and urban agency differences in rates of unplanned urgent care and hospital admissions were not statistically significant after controlling for other agency characteristics, region of country and characteristics of the health care market.

Data for this project was obtained from the Medicare Providers of Services file and the Medicare Home Health Compare (HHC) database.

Related Links

Sutton, J. 2007. "Outcomes in Rural and Urban Home Health Agencies." Home Health Care Management & Practice, 19(3):196-202. External link.

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Sutton, J. 2006. "Performance of Rural and Urban Home Health Agencies in Improving Patient Outcomes." Report to the Federal Office of Rural Health Policy.  Washington, DC.  May.  (514K)