Rural and urban disparities in quality of home health care: A longitudinal cohort study (2014-2018).

PURPOSE: Home health care is one of the fastest growing health care sectors in the United States. However, little is known of differences in trends in quality performance between rural and urban home health agencies over time. This study aimed to examine disparities in quality performance between rural and urban home health agencies between 2014 and 2018. METHODS: This is a cohort study using 2014-2018 national Home Health Compare data and Providers of Service Profile data, including 7,908 home health agencies, of which 1,537 were rural agencies. Quality performance measures included timely initiation of care, hospitalization, and emergency department (ED) visits. Two-level hierarchical regression models were used to identify rural-urban differences in these quality indicators over time when controlling organizational characteristics. FINDINGS: Rural agencies were less likely to be for-profit and accredited, and more likely to be hospital-based, serve both Medicare and Medicaid beneficiaries, and have hospice programs. Rural agencies consistently outperformed on timely initiation of care over time, and urban agencies consistently outperformed on hospitalization and ED visits over time. These gaps between rural and urban agencies were steady over time except the gap in hospitalization, which slightly narrowed over time (Coef. = 0.11, P = .001 for urban and year interaction term). CONCLUSIONS: Significant differences exist in quality of care between rural and urban home health agencies and such differences have not been significantly narrowed over time. To reduce rural-urban disparities, policy makers should take into account unique challenges faced by urban and rural agencies when making policy decisions.

Immunotoxic effects of triclosan in the clam Ruditapes philippinarum.

The effects of Triclosan (TCS) on the immune parameters of the clam Ruditapes philippinarum were investigated after a 7-day exposure to sublethal TCS concentrations (300, 600, and 900 ng l(-1)). Hemocytes from controls and exposed clams were collected, and the effects of TCS on total hemocyte count (THC), hemocyte diameter and volume, uptake of the vital dye Neutral Red (an indicator of pinocytosis), lysozyme activity, and proliferation were evaluated. The cytotoxicity, which was evaluated using the lactate dehydrogenase assay, and the capability of TCS to induce DNA fragmentation, which indicated apoptosis, were also investigated. The exposure of clams to all tested TCS concentrations significantly decreased THC, whereas the highest tested TCS concentration significantly reduced the diameter and volume of hemocytes. TCS negatively affected pinocytosis and the proliferation of hemocytes, but it did not alter hemocyte lysozyme activity. TCS exerted cytotoxic effects and induced DNA fragmentation in hemocytes of R. philippinarum. Overall, these results suggest a relationship between TCS exposure and changes in the measured immune parameters and indicate immunosuppression in TCS-treated clams.