Improving Nursing Home Compare for Dually Eligible Consumers

描述（由申请人提供）：同时参加Medicare和Medicaid（通常称为双重资格或“双重资格”）的个人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。双胞胎是一个脆弱的人群，因为他们通常比整个老年人口更生病，更有可能需要长期护理，更有可能在低资源社区接受护理，并且受到医疗保险和医疗补助的不一致和冲突的政策激励。养老院是照顾老年人的主要场所。长期以来，养老院一直是人们关注的目标，因为护理质量低下，而老年人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提高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，市场份额的反应很小，而且不一致。这些不冷不热的影响令人失望，有些令人困惑，但它们可能掩盖了影响的实质异质性--与非护理院比较相比，护理院比较可能不太可能对护理院比较做出反应并从中受益。我们的初步工作表明，与其选择更高质量的设施， 在公开报道下，他们倾向于进入低质量的设施。在这个混合方法的项目中，我们建议检查在何种程度上受益（或不）从护理之家比较，评估的重要性，限制访问的护理之家比较，以防止更多的使用护理之家比较选择更高质量的护理之家，定性评估的障碍，护理之家比较，这样的改进报告卡可以探索。特别是，如果一个人1）住得离高质量的家太远; 2）依赖医疗补助，而高质量的家没有医疗补助床位; 3）难以访问或解释质量信息，则有关养老院质量的信息可能没有帮助。通过评估阻碍有效使用Nursing Home Compare by Nursing的相对重要性，我们将确定最有前途的进一步投资途径，例如，提高质量报告的可用性与提高可用性 高质量的供应商。这些是影响特别弱势群体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提高护理质量的疗养院居民谁是双重参加医疗保险和医疗补助（“医保”）通过严格审查和开发改进的一项重大政策举措-质量信息的公开报告-在其影响方面，并使用，相对于其他消费者的医保。 老年人是一个特别脆弱的群体，他们的保健开支和利用率不成比例;因此，重大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.