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Home Health Clinician Bias Negatively Affects Quality of Care

Analysis  |  By Jasmyne Ray  
   August 18, 2023

A clinician's biases can alter care decisions for their patients, negatively affecting health outcomes.

A clinician's bias toward their patients can negatively affect the quality of care home health clinicians provide, says a recent study from the Columbia University School of Nursing.

Using data from an urban home health organization, results found that home health clinicians spend less time with patients "for whom they document the language of judgment"—words like "adamant," "apparently," "claims," and "insists"—which allows them to distance themselves from the source of knowledge and question the speaker's credibility.

"Although quality of care is affected by numerous factors, a [home health] clinician's biased behavior towards patients can affect quality of care," the study stated.

An example would be evaluating one racial or ethnic group negatively in comparison to another.

Such biases, it explained, affect the home health clinicians' behaviors and care decisions regarding their patients, which then impact how patients comply with their treatment and ultimately affect their health outcomes.

Results showed that judgment language was used for just over 17,000 patients—38% of the overall sample—with 10% of all clinical notes found to have judgment language.

Judgment language was more frequently documented in clinical notes referring to Black or Hispanic patients, with these two groups having up to 9% higher odds of this occurring than White patients.

The study considers a few explanations to describe the difference, including how home health clinicians' personal biases might show up in written documents. The analysis also shows how some home health clinicians are more likely to use judgment language than others.

Conversely, the research team noted that judgment language may not be the result of biases but influenced by specific circumstances of the patient-provider interaction. The use of judgment language may even increase in reference to patients with more complex health conditions.

As more patients prefer receiving care in the home and older adults choose to age in place, the demand for home health services has grown exponentially over the last few years. According to the study, around 200,000 home health clinicians—this estimation includes RNs, physical and occupational therapists, and social workers—treat over five million patients each year.

Around 25% of home health patients are part of racial or ethnic minority population, such as Black or Latinx groups, which is why the movement to diversify clinicians is crucial to better healthcare.

Diverse home care clinicians bring shared life experiences with their patients and the ability to understand the culture and establish partnerships and communication with their minority patients, studies have indicated

Rafael Fantauzzi, chief diversity, equity, and inclusion officer for AccentCare, a home health provider, is working to increase diversity among his company’s clinicians.

Following the formula of belongingness + uniqueness = inclusion, and releasing a breakdown of the organizational demographic data, Fantauzzi's goal is to set an example for the home health space for its workforce to reflect the patients they care for.

"I think it's an encouragement to my counterparts in other organizations for us to work together toward trying to increase the workforce pipeline," he said. "But also, to elevate the quality of service because when we are intentional about including folks that are in our communities, we will service them better."

Jasmyne Ray is the revenue cycle editor at HealthLeaders. 


The study found that home health clinicians spend less time with patients they describe with judgement language in their notes.

Black and Hispanic patients were found to have 9% higher odds of their clinicians using judgement language to describe them.

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