In this project, I will collaborate closely with my team to identify disparities in access to home-based palliative care (HPC) among older adults. This will involve utilizing national datasets, specifically CMS datasets, as well as electronic health records (EHRs) from VNA Care. Through the implementation of this project, I foresee substantial opportunities for collaboration, intellectual exchange, engagement in public policy discussions, and participation in community outreach activities.

The accessibility of Home-based Palliative Care (HPC) for frail older adults with serious illnesses varies across the U.S. due to differences in health insurance coverage, notably within Medicare. Medicare lacks a distinct palliative care benefit, leading to uncertainty regarding HPC coverage. The CHRONIC Care Act targets improvements in care for individuals with chronic conditions, potentially affecting HPC accessibility via Medicare Advantage plans. This proposal aims to assess HPC utilization before, during, and after the CHRONIC Care Act through national data analysis and interviews with the Visiting Nurses Association (VNA) Care in MA. We anticipate disparities in HPC access among subgroups based on socioeconomic status, insurance type, geographic location, education, and cognitive barriers. Our goal is to
identify and mitigate these barriers to promote health equity for frail older adults with serious illnesses. Understanding these disparities is crucial for informing policymakers, healthcare providers, and public health professionals in crafting tailored strategies to enhance public health interventions for this vulnerable population.

Aim 1. To characterize subgroups in receiving HPC before (2018-2019), during 2020, and after the CHRONIC act period (2021-2022), using CMS claims datasets- Master Beneficiary Summary File (MSBF- demographic), Part B (outpatient- outpatient visits including HPC), Carrier Claims (NCH – non-institutional providers including HPC), and Home Health Agency. * Because there is no standard Medicare definition for HPC, outside of Hospice, our approach will initiate with the use of 'provider specialty codes' and CD diagnosis 'codes' for encounters elated to HPC.

Aim 2. To explore the barriers and facilitators affecting accessibility and utilization of HPC by conducting interviews with healthcare providers, families, and patients. [Qualitative Data]