Identifying Associations between Quality Initiatives and Quality Measures among Home Health Agencies: Findings from a National Study.
Identifying Associations between Quality Initiatives and Quality Measures among Home Health Agencies: Findings from a National Study.
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DOI：
10.1177/1178632921992092
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发表时间：
2021
影响因子：
2.8
通讯作者：
Mukamel DB
中科院分区：
文献类型：
--
作者：
Zinn JS;Ladd H;Nuccio E;Ettner SL;Sorkin DH;Mukamel DB
家庭健康绩效随着家庭健康比较和家庭健康基于价值的支付示范的出版而获得了可见度。两者都为家庭保健机构（HHA）投资于质量改进提供了激励。本研究的目的是确定HHA采用的质量举措和改进的性能之间的关联。2018年对7459名HHA进行的一项全国性调查，产生了1192名合格HHA的样本，提供了有关23项质量举措的信息，这些举措与5项复合超级质量指标（SQM）有关：ADL/疼痛，自我治疗，及时护理，住院和患者体验。缺失数据和离群值的排除产生了903个HHA的最终分析样本。回归模型估计质量倡议和SQM之间的关联。16个SQM/质量倡议对之间的关系与改进呈正相关，7个呈负相关。为工作人员和护理人员提供的基于网络的技术提高了绩效，但恶化了患者体验。工作人员网络支持小组和HHC排名审查降低了住院率。虽然这项研究提供了质量改进的见解，一个限制可能是缺乏敏感性的细微差别，质量改进的实施。因此，本研究应被视为对可能具有最大潜力值得进一步调查的举措提出假设。
Home health performance gained visibility with the publication of Home Health Compare and the Home Health Value-Based Payment demonstration. Both provide incentives for home health agencies (HHA) to invest in quality improvements. The objective of this study is to identify the association between quality initiatives adopted by HHAs and improved performance. A 2018 national survey of 7459 HHAs, yielding a sample of 1192 eligible HHAs, provided information about 23 quality initiatives, which was linked to 5 composite Super Quality Measures (SQMs): ADL/pain, self-treatment, timely care, hospitalizations, and patient experience. Exclusions for missing data and outliers yielded a final analytical sample of 903 HHAs. Regression models estimated associations between quality initiatives and SQMs. The relationships between sixteen of the SQM/quality initiative pairs were positively associated with improvement and 7 were negatively associated. Web-based technologies for staff and care-givers improved performance but deteriorated patient experience. Web support-groups for staff and review of HHC rankings reduced hospitalization rates. While this study offers insights for quality improvement, a limitation may be a lack of sensitivity to the nuances of quality improvement implementation. Therefore, this study should be viewed as hypothesis-generating concerning initiatives likely to have the greatest potential meriting further investigation.