Dissertation is one of the first papers to look at disparities in home health care health outcomes for people living with serious illnesses.
While health disparities have been well studied and documented among patients in primary and inpatient care, similar research has been lacking for seriously ill people who receive Medicare home health care (HHC). Dr. Tessa Jones, MSW ’14/PhD ’23, helped fill that gap with her dissertation, titled “Racial Health Equity in Medicare Home Health Care for Seriously Ill Older Adults,” for which she received NYU Silver’s Robert Moore Award for Excellence in Scholarship.
“A growing number of older adults who are seriously ill are choosing to live at home, which is tied to independence, autonomy, identity, and a connection to community,” said Dr. Jones, who is now a T32 Postdoctoral Fellow in the Cancer Prevention and Control in Priority Populations at the Icahn School of Medicine at Mount Sinai. “Thus it is of urgent concern that an understanding of racial health equity be established for seriously ill persons in the HHC setting.”
For the three-part dissertation, Dr. Jones conducted an analysis of a large national dataset of Medicare beneficiaries, HHC providers and patient outcomes to examine 1) the relationship between race and ethnicity of seriously ill HHC recipients and health outcomes; 2) HHC agency quality; and 3) neighborhood-level socioeconomic disadvantage and HHC agency quality.
Among her findings were that, across most indicators, seriously ill underrepresented racial and ethnic groups had worse HHC health outcomes than non-Hispanic White patients. Setting aside neighborhood-level variations, Black or African American Medicare beneficiaries were less likely than non-Hispanic White counterparts to receive care from agencies rated high-quality. Living in a socioeconomically disadvantaged area had a negative impact on one’s probability of receiving care from a high-quality rated agency, and the impact of race and ethnicity on access to high-quality HHC was shown to persist regardless of the level of socioeconomic disadvantage in a given neighborhood.
Dr. Jones’ passion for addressing the needs of seriously ill people dates back to her time in NYU Silver’s MSW program, when she was an MSW Fellow in the School’s Zelda Foster Studies Program in Palliative and End-of-Life Care.
“In the United States, the health care of seriously ill older adults in the community is largely fulfilled by Medicare HHC,” said Dr. Jones. “Considering the rate at which the United States’ demographic is aging, and the proportionally high cost of caring for older adults, providing equitable high quality HHC must be made a priority.”
The Robert Moore Award is a $1,000 cash award. It was established in 2009 in recognition of the many contributions to the PhD Program and the School made by Professor Robert Moore, who passed away in 2008.