Improving Nursing Home Compare for Dually Eligible Consumers

描述(由申请人提供)：同时参加联邦医疗保险和医疗补助的个人(通常被称为双重资格或“双重资格”)吸引了越来越多的健康政策关注 近几十年来，由于他们不成比例地使用卫生保健服务和费用。双胞胎是一个弱势群体，因为他们的病情通常比老年人口整体更严重，更有可能需要长期护理，更有可能在资源匮乏的社区接受护理，并且受到联邦医疗保险和医疗补助政策激励的错位和冲突。疗养院是照顾双胞胎的主要场所。疗养院部门长期以来一直是低质量护理的关注目标，而双胞胎往往受到这些质量问题的不成比例的影响。2002年，医疗保险和医疗补助服务中心发起了一项公共报告倡议(疗养院比较)，旨在通过引导消费者到更高质量的疗养院来改善疗养院居民的护理质量。然而，对消费者对养老院比较的反应的研究表明，市场份额反应很小且不一致。这些不温不火的效果令人失望，也有些令人费解，但它们可能掩盖了效果的实质性异质性--与非双性人相比，双性人可能更不可能对《养老院》做出反应，也不太可能从中受益。我们的初步工作表明，不是选择更高质量的设施，而是增加了双人 他们倾向于在公共报告中被允许进入低质量的设施。在这个混合方法项目中，我们建议检查DUAL从疗养院比较中受益(或不受益)的程度，评估DUAL限制访问在防止更多地使用疗养院方面的重要性，比较选择更高质量的疗养院，定性地评估DUAL使用NOR的障碍，以便探索对成绩单的改进。特别是，如果个人1)居住在离高质量家庭太远的地方；2)依赖医疗补助，并且高质量家庭中没有医疗补助床位；3)难以获取或解释质量信息，则有关疗养院质量的信息可能无济于事。通过评估有效使用疗养院的障碍的相对重要性，我们将确定进一步投资的最有前景的途径，例如，提高质量报告的可用性与改善可用性 高质量的供应商。这些是影响特别脆弱人口获得高质量护理的关键区别。 公共卫生相关性：我们在这项研究中的总体目标是，通过批判性地检查和改进一项主要政策倡议-公开报告高质量信息-相对于其他消费者对双重保险和医疗补助(DUAL)的影响和使用，来提高参加联邦医疗保险和医疗补助(DUAL)的疗养院居民的护理质量。 这两个群体是一个特别脆弱的群体，负责不成比例的卫生保健支出和利用；因此，主要政策对这一群体的影响是一个关键的政策问题。

DESCRIPTION (provided by applicant): Individuals who are enrolled in both Medicare and Medicaid (often called dually eligible or "duals") have attracted increased health policy attention in recent decades due to their disproportionate use of health care services and costs. Duals are a vulnerable population as they are generally sicker than the elderly population as a whole, more likely to be in need of long-term care, more likely to receive care in low-resource neighborhoods, and are subject to misaligned and conflicting policy incentives from Medicare and Medicaid. Nursing homes are a major site of care for duals. The nursing home sector has long been a target of concern about low quality of care, and duals are often disproportionately affected by these quality problems. In 2002 the Centers for Medicare and Medicaid Services launched a public reporting initiative (Nursing Home Compare) aimed at improving quality of care for nursing home residents in part by guiding consumers to higher quality nursing homes. However, studies of consumer response to Nursing Home Compare have revealed a small and inconsistent market share response. These lukewarm effects have been disappointing and somewhat puzzling, but they may be masking substantial heterogeneity of effect-duals may be much less likely to respond to, and benefit from, Nursing Home Compare than non-duals. Our preliminary work reveals that, rather than choosing higher-quality facilities, duals have increased their propensity to be admitted to low- quality facilities under public reporting. In this mixed methods project, we propose to examine the extent to which duals have benefited (or not) from Nursing Home Compare, to assess the importance of constrained access by duals in preventing greater use of Nursing Home Compare to choose higher-quality nursing homes, to assess qualitatively the obstacles to duals' use of Nursing Home Compare such that improvements to the report cards may be explored. In particular, information about the quality of nursing homes may not be helpful if an individual 1) lives too far from a high-quality home; 2) depends on Medicaid and no Medicaid beds are available in the high-quality homes; 3) has difficulty accessing or interpreting the quality information. By assessing the relative importance of barriers to effective use of Nursing Home Compare by duals, we will identify the most promising avenues for further investment, e.g. improved usability of quality reports vs improved availability of high-quality providers. These are crucial distinctions affecting access to high-quality care fora particularly vulnerable population. PUBLIC HEALTH RELEVANCE: Our overall goal in this study is to improve the quality of care for nursing home residents who are dually enrolled in Medicare and Medicaid ("duals") by critically examining and developing improvements to a major policy initiative -public reporting of quality information- in terms of its effects on, and use by, the duals relative to other consumers. The duals are a particularly vulnerable population responsible for disproportionate health care spending and utilization; thus the effects of major policies on this population is of key policy concern.