The Impact of Public Reporting on the Quality of Post-Acute Care

描述（由申请人提供）：我们建议调查公开报道的质量信息对美国养老院提供给急性期后护理居民的护理质量的影响。研究记录了美国医疗保健质量差，这引起了医疗保健消费者、提供者和决策者的关注。为了提高卫生保健质量，决策者已转向基于市场的改革，例如基于网络的质量措施公开报告和按绩效付费战略。这些举措旨在通过以下方式提高保健质量：1)激励个体提供者提高其提供的保健质量；2)通过为患者提供识别和选择优质提供者的方法，增加接受高质量护理的患者数量。尽管人们热衷于以市场为基础的改革，并广泛采用这些方法，但尚不清楚这些努力是否真正提高了医疗质量，如果确实如此，则通过何种途径。由于难以确定所观察到的提供者质量的提高是“真正的”质量改善，还是提供者在改革后选择更健康的病人的结果，对质量改进的衡量变得复杂。本研究的总体目标是检验最近实施的要求公开报告熟练护理机构急性后护理质量的改革（疗养院比较）是否导致了护理质量的提高。使用来自最低数据集和医疗保险索赔的数据，本项目将测量疗养院比较中使用的急性后护理质量指标的变化以及急性后护理居民再住院率的变化。第一个目标是评估公共报告可能提高质量的两种方式：1)改善设施内部的质量，2)增加高质量设施的市场份额。第二个目的是评估市场层面的因素和患者人口特征是否与养老院质量措施的公开报告导致的护理质量的更大变化有关。目标1和目标2的分析将使用最优1-1倾向评分匹配明确控制基于健康风险的患者选择。最后，第三个目标直接衡量患者的选择，并直接比较这些变化与质量指标的真实变化。这将是第一个严谨的分析，为关于急性后护理部门公开报告的好处和风险的政策辩论提供信息。

DESCRIPTION (Provided by applicant): We propose to investigate the impact of publicly reported quality information on quality of care delivered to post-acute care residents in US nursing homes. Research documenting the poor quality of health care in the US has caused concern among health care consumers, providers, and policy makers. In an effort to improve health care quality, policy makers have turned to market-based reforms, such as web-based public reporting of quality measures and pay-for-performance strategies. These initiatives are designed to improve health care quality by 1) motivating individual providers to improve the quality of care they provide; and 2) increasing the number of patients receiving high-quality care by providing a way for patients to identify and choose high-quality providers. Despite the enthusiasm for market based reforms and the widespread adoption of these methods, it is unknown whether these efforts truly improve quality of care, and if they do, through which pathway. The measurement of quality improvement is complicated by the difficulty in determining whether the observed increases in provider quality are "true" quality improvements or whether they are the result of providers selecting healthier patients after reforms. The overall objective of this study is to test whether the recently instituted reform requiring publicly reporting of quality of post-acute care in skilled nursing facilities (Nursing Home Compare) resulted in improved quality of care. Using data from the Minimum Data Set and Medicare claims, this project will measure changes in the post-acute care quality measures used in Nursing Home Compare and changes in rehospitalization rates among post-acute care residents. The first aim is to assess two ways in which public reporting may improve quality: 1) improvements in quality within facilities and 2) increasing market share of high quality facilities. The second aim is to assess whether market-level factors and patient demographic characteristics are associated with greater changes in quality of care as a result of public reporting of nursing home quality measures. The analyses for aims 1 and 2 will explicitly control for patient selection based on health risk using optimal 1-1 propensity score matching. Finally, the third aim directly measures patient selection and directly compares these changes with true changes in performance on quality measures. This will be the first rigorous analysis to inform the policy debate on the benefits and risks of public reporting in the post-acute care sector.