Disparities in Timely Access to Postoperative Home Health Care and Functional Recovery After Joint Replacement by Rurality and Dual Eligibility.

OBJECTIVES

To examine the association of dual-eligible (DE) status and rural residence with timely initiation of home health (HH) care and subsequent physical function following hip and knee replacement.

METHODS

This retrospective cohort study used 2021 to 2023 national Medicare claims data of 18,998 Medicare fee-for-service and Medicare Advantage beneficiaries aged ≥65 years, discharged to HH following hip or knee replacement. The exposure variable was urban and rural residents and dual eligibility vs nondual status. The study outcome includes (1) timely initiation of HH rehabilitation, defined as initiation of physical therapy or occupational therapy within 2 days after hospital discharge, (2) change in physical function measured by the difference in mobility score between initiation and discharge from the HH.

RESULTS

Among 18,998 patients (7341 hip replacements and 11,657 knee replacements), 3192 (17%) experienced delayed HH initiation. After adjusting for patient-, provider-, and market-level factors, rural and DE beneficiaries have a lower likelihood of timely HH initiation (odds ratio [OR], 0.84; 95% CI, 0.73-0.97) and (OR, 0.80; 95% CI, 0.70-0.91), respectively, compared with their counterparts. In addition, rural and DE beneficiaries had lower odds of mobility improvement (OR, 0.80; 95% CI, 0.70-0.91) and (OR, 0.68; 95% CI, 0.59-0.78), respectively, compared with their counterparts.

CONCLUSIONS AND IMPLICATIONS: Rural and DE Medicare beneficiaries hospitalized for hip or knee replacement experience substantially lower rates of timely HH initiation and functional recovery. These findings underscore the urgent need for targeted quality improvement initiatives to enhance access and timeliness of HH services in these underserved populations.