Changes in Patient Sorting to Nursing Homes under Public Reporting: Improved Patient Matching or Provider Gaming?
Changes in Patient Sorting to Nursing Homes under Public Reporting: Improved Patient Matching or Provider Gaming?
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DOI：
10.1111/j.1475-6773.2010.01205.x
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发表时间：
2011-04-01
影响因子：
3.4
通讯作者：
Polsky, Daniel
中科院分区：
文献类型：
--
作者：
Werner, Rachel M.;Konetzka, R. Tamara;Polsky, Daniel
目的测试在疗养院的急性期后护理设置中的公共报告是否导致患者分类的变化。数据来源/研究设置2001年至2003年疗养院最小数据集的所有急性期后护理入院。研究设计我们测试患者分类的变化（或前往高分设施与低分设施的患者的疾病严重程度变化）当2002年养老院开始公开报道时，我们测试疼痛，谵妄和行走方面的分类变化，然后研究撇奶油和向下编码在患者分类变化中的潜在作用。我们使用一个差异中的差异框架，利用试点和非试点国家的公共报告启动的变化，以控制潜在的趋势，在病人sorting.Principal FindingsThere是一个显着的变化，病人排序相对于疼痛后，公共报告启动，高风险患者更可能去高分机构，而低风险患者更可能去低分机构。随着公开报告的启动，患者疼痛风险也整体降低，这可能与疼痛水平记录（或编码下调）的变化一致。排序谵妄或walking.ConclusionsPublic报告的护理之家的质量提高了匹配的高风险患者的高质量的设施没有显着的变化。然而，应努力减少护理机构对降码的激励。
ObjectiveTo test whether public reporting in the setting of postacute care in nursing homes results in changes in patient sorting.Data Sources/Study SettingAll postacute care admissions from 2001 to 2003 in the nursing home Minimum Data Set.Study DesignWe test changes in patient sorting (or the changes in the illness severity of patients going to high- versus low-scoring facilities) when public reporting was initiated in nursing homes in 2002. We test for changes in sorting with respect to pain, delirium, and walking and then examine the potential roles of cream skimming and downcoding in changes in patient sorting. We use a difference-in-differences framework, taking advantage of the variation in the launch of public reporting in pilot and nonpilot states, to control for underlying trends in patient sorting.Principal FindingsThere was a significant change in patient sorting with respect to pain after public reporting was initiated, with high-risk patients being more likely to go to high-scoring facilities and low-risk patients more likely to go to low-scoring facilities. There was also an overall decrease in patient risk of pain with the launch of public reporting, which may be consistent with changes in documentation of pain levels (or downcoding). There was no significant change in sorting for delirium or walking.ConclusionsPublic reporting of nursing home quality improves matching of high-risk patients to high-quality facilities. However, efforts should be made to reduce the incentives for downcoding by nursing facilities.