Public Reporting and Market Area Exit Decisions by Home Health Agencies

描述(由申请人提供)：在过去的十年中，医疗保健领域积极推动对质量信息的公开报告，期望它能激励提供者提高质量。随着公共报告迅速扩展到几个环境，人们提出了一个重要的政策关切，即公共报告可能无意中加剧卫生保健方面的差距。公共报告计划可能会使服务于未得到充分服务的人群的提供者处于不利地位，他们的护理质量可能需要付出高昂的代价才能改善。这意味着，这些提供者可能从公共报告方案中获得的经济回报很少，为了避免这一劣势，他们可能会减少对服务不足的人的服务，或者将社区留给这些人口。我们拟议的研究将审查家庭健康比较(HHC)，这是一项医疗保险公共报告倡议，对弱势群体获得家庭卫生保健的影响。具体地说，我们将研究在2003年联邦医疗保险引入HHC后，机构是否有选择地停止向社会经济弱势人口地区提供服务。我们将通过分析2002至2004年间的市场区域退出来评估机构对HHC的初步反应。我们将使用结果和评估信息系统(OASIS)数据确定各机构的服务领域，并将从人口普查文件和地区资源文件(ARF)获得市场区域信息。我们将使用Logit估计来分析数据，并将使用通用估计方程(GEE)技术来解释机构内的集群。这项研究的结果将为政策制定者提供重要信息，可用于设计或改进公共报告计划。 公共卫生相关性：随着对家庭卫生保健需求的增加，确保获得高质量的家庭卫生保健至关重要。这项研究建议审查公共报告计划对社会经济弱势群体获得家庭卫生保健的影响。具体地说，拟议的研究将考察家庭健康机构在公开报告后是否停止向弱势人口市场地区提供服务。

DESCRIPTION (provided by applicant): Public reporting of quality information has been actively promoted in health care during the past decade, with the expectation that it gives providers an incentive to improve quality. As public reporting rapidly expands to several settings, an important policy concern has been raised that public reporting may unintentionally exacerbate disparities in health care. Public reporting programs may disadvantage providers serving underserved populations, whose quality of care may be costly to improve. This implies that those providers may receive little financial rewards from public reporting programs, and to avoid this disadvantage, they may reduce services for underserved people or leave communities with those populations. Our proposed study will examine the impact of Home Health Compare (HHC), a Medicare public reporting initiative, on access to home health care among disadvantaged populations. Specifically, we will examine whether agencies selectively discontinued service to areas with socio-economically disadvantaged populations after Medicare introduced HHC in 2003. We will assess agencies' initial responses to HHC by analyzing market area exits between 2002 and 2004. We will identify agencies' service areas using the Outcome and Assessment Information System (OASIS) data and will obtain market area information from the Census file and Area Resource File (ARF). We will use logit estimation to analyze the data and will account for clustering within an agency employing the Generalized Estimating Equations (GEE) technique. The findings of this study will provide policy makers with important information that can be used to design or refine public reporting programs. PUBLIC HEALTH RELEVANCE: As demand for home health care increases, ensuring access to high quality home health care is essential. This study proposes to examine the impact of a public reporting program on access to home health care among socio-economically disadvantaged populations. Specifically, the proposed study will look at whether home health agencies discontinue service to market areas with disadvantaged populations after public reporting.