Disparities in outpatient and home health service utilization following XXXX : results of a 9-year cohort study in Northern California.

@entity1 @entity64 @entity385
OBJECTIVE: To examine whether there are disparities in utilization of outpatient and home care services after @entity64 . DESIGN: Retrospective cohort study. SETTING: The Kaiser Permanente of Northern California health care system, which provides health care for approximately 3.3 million members. @entity1 : A total of 11,119 @entity1 hospitalized for a @entity64 between 1996 and 2003 and followed for 1 year. MAIN OUTCOME MEASURES: Receipt of outpatient rehabilitation (physical therapy, occupational therapy, speech pathology, or physical medicine and rehabilitation/physiatry visits), and/or home health care. RESULTS: There were significant differences in outpatient rehabilitation visits and home health enrollment during the year after acute care discharge for all the parameters under study. Older age and female gender were associated with less outpatient rehabilitation treatment, but these subpopulations were more likely to be enrolled in home health care. Non-whites, @entity1 from urban areas, those with @entity385 , and those with longer acute care hospital stays had relatively more outpatient rehabilitation and were also more likely to be enrolled in the home health program. In addition, @entity1 living in geographic areas with a median household income of  80,000 or more had significantly more outpatient rehabilitation visits than did @entity1 living in lower income areas. CONCLUSIONS: Variations in outpatient rehabilitation visits and in home health care exist in this large integrated health system in terms of age, gender, race/ethnicity, residence area, type of @entity64 , and length of stay in an acute care hospital. The Kaiser Permanente integrated health care system seems to have outpatient @entity64 rehabilitation and home health programs that are providing care without disparities in relation to non-white populations, but other disparities appear to exist that may be related to socioeconomic factors, referral patterns, family support systems, or other cultural factors that have not been identified.
