Effect of locale on health status and direct care time of rural versus urban home health patients

Objective: The study purpose was to determine if health status differed bet ween rural versus urban home health patients and to identify if locale was a significant predictor of home health direct care time, Background: Implemented in October 2000, the Medicare home health prospecti ve payment system (PPS) made only temporary allowance for differences in co st of delivering home health sen ices in rural versus urban environments. H owever, past research documented differences in health status and service u tilization between rural and urban home health patients. Methods: Data were collected retrospectively on a convenience sample of 2,7 88 patient episodes of care. Patient: health status was measured using item s form the Outcome Assessment and Information Set (OASIS). Obtained from it inerary records, direct care time was the time clinicians spent in the home . Results: Tile results showed significant differences in rural versus urban patients health status, with urban patients being healthier than rural pati ents. Consistent with poorer health status, rural patients received more RN direct care time. Other study factors being equal,living in a rural locale increased total direct tart time by 150 minutes over living in an urban en vironment. Conclusions: Given the poorer health status and increased time requirements for rural patients, the results support assertions that Medicare per episo de reimbursement should be higher for rural than for urban home health pati ents.