所有权变更与居家医疗机构的护理质量。

IF 9.5 Q1 HEALTH CARE SCIENCES & SERVICES JAMA Health Forum Pub Date : 2024-11-01 DOI:10.1001/jamahealthforum.2024.3767
Zhanji Zhang, Kun Li, Siyi Wang, Shekinah Fashaw-Walters, Yucheng Hou
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引用次数: 0

摘要

重要性:家庭保健机构(HHA)市场的所有权交易变化越来越多。人们对所有权变更后家庭医疗机构的组织特征和护理质量知之甚少:目的:研究家庭医疗机构所有权变更是否与不同的护理质量结果、患者数量和人员配置水平有关:这项交错差异分析利用当前的 HHA 所有权变更文件与公开的 Medicare HHA 数据相链接,评估了 2016 年第 1 季度至 2019 年第 4 季度期间 Medicare 认证的 HHA 所有权变更交易。在所有权发生变化的 HHA 和多达 8 个匹配对照之间比较了交易前和交易后 HHA 的特征和护理质量结果。主要分析中的交易包括:(1)所有权发生变化但仍为营利性的 HHA;(2)HHA 的所有权从非营利性/公共性转变为营利性。数据分析时间为 2023 年 11 月至 2024 年 9 月:主要结果包括 HHA 季度星级评定、基于结果和评估信息集的星级评定的单项质量指标,以及基于索赔的质量指标,如住院和急诊就诊。次要结果包括医疗保险(Medicare)患者数量、人均支付和人员配备水平(全职当量和每次就诊分钟数)的 HHA 年度衡量指标:主要数据集包括 294 家经联邦医疗保险认证、所有权发生变更的 HHA,以及 2330 家对照机构。在所有权变更后的 3 年内,季度星级评分相对于匹配的对照组提高了 0.18(95% CI,0.05-0.31),其中从非营利/公立转为营利的医疗保健机构的星级评分提高幅度更大。在 60 天入院率或门诊急诊就诊率方面没有观察到明显改善。此外,在医疗保险受益人数量方面也没有观察到明显变化,但在所有权改变后的两年内,人均支付额有所增加。在相当于全职的注册护士(-17% [95% CI, -31% to -3%])和家庭健康助理(-26% [95% CI, -39% to -13%])以及专业护理(-5% [95% CI, -9% to -1%] )、物理治疗(-3% [95% CI, -5% to 0%])和家庭健康助理护理(-11% [95% CI, -15% to -6%])的每次就诊分钟数方面,观察到了显著的减少:在这项对获得医疗保险认证的保健护理机构进行的差异分析中,所有权变更与较高的星级评定和医疗保险人均支付有关,但与基于索赔的质量衡量标准无关。所有权变更后人员配备水平的降低引发了对护理质量影响的担忧。
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Change of Ownership and Quality of Home Health Agency Care.

Importance: The home health agency (HHA) market has seen increasingly more change in ownership transactions. Little is known about the organizational characteristics and quality of care of HHAs after ownership has changed.

Objective: To examine whether an HHA change in ownership was associated with different quality-of-care outcomes, patient volume, and staffing levels.

Design, setting, and participants: Using current HHA change of ownership files linked to publicly available Medicare HHA data, this staggered difference-in-differences analysis evaluated ownership change transactions of Medicare-certified HHAs from quarter 1 of 2016 to quarter 4 of 2019. Pretransaction and posttransaction HHA characteristics and quality-of-care outcomes were compared between HHAs that changed ownership and up to 8 matched controls. The transactions in the main analysis included (1) when an HHA remained as for-profit with a change in ownership and (2) when an HHA changed from nonprofit/public to for-profit ownership. The data were analyzed between November 2023 and September 2024.

Main outcomes and measures: The primary outcomes were HHA-quarter measures of star ratings, the individual quality measures that compose the star ratings based on the Outcome and Assessment Information Set, and claims-based quality metrics, such as hospitalizations and emergency department visits. The secondary outcomes included HHA year measures of Medicare patient volume, per capita payments, and staffing levels (full-time equivalents and minutes per visit).

Results: The main dataset included 294 Medicare-certified HHAs that changed ownership, matched with 2330 controls. In 3 years after an ownership change, quarterly star ratings increased by 0.18 (95% CI, 0.05-0.31) relative to matched controls, with greater increases among HHAs that converted from nonprofit/public to for-profit. No significant improvement was observed in the 60-day rates of hospital admissions or outpatient emergency department visits. Further, no significant changes were observed in the number of Medicare beneficiaries, but per capita payments increased within 2 years post-ownership change. Significant reductions were observed in full-time equivalents of registered nurses (-17% [95% CI, -31% to -3%]) and home health aides (-26% [95% CI, -39% to -13%]), as well as per-visit minutes for skilled nursing care (-5% [95% CI, -9% to -1%]), physical therapy (-3% [95% CI, -5% to 0%]), and home health aide care (-11% [95% CI, -15% to -6%]).

Conclusions and relevance: In this difference-in-differences analysis of Medicare-certified HHAs, ownership change was associated with higher star ratings and Medicare per capita payments, but not with claims-based quality measures. Reduction in staffing levels after ownership change raises concerns about implications for quality of care.

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期刊介绍: JAMA Health Forum is an international, peer-reviewed, online, open access journal that addresses health policy and strategies affecting medicine, health, and health care. The journal publishes original research, evidence-based reports, and opinion about national and global health policy. It covers innovative approaches to health care delivery and health care economics, access, quality, safety, equity, and reform. In addition to publishing articles, JAMA Health Forum also features commentary from health policy leaders on the JAMA Forum. It covers news briefs on major reports released by government agencies, foundations, health policy think tanks, and other policy-focused organizations. JAMA Health Forum is a member of the JAMA Network, which is a consortium of peer-reviewed, general medical and specialty publications. The journal presents curated health policy content from across the JAMA Network, including journals such as JAMA and JAMA Internal Medicine.
期刊最新文献
Cannabis Use During Early Pregnancy Following Recreational Cannabis Legalization. Change of Ownership and Quality of Home Health Agency Care. Errors in Conflict of Interest Disclosures. JAMA Health Forum. Surgeon Workforce in Underserved Communities.
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