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告的质量信息对美国养老院急性护理后住院医师护理质量的影响。研究记录了美国医疗保健质量差，引起了医疗保健消费者，提供者和政策制定者的关注。为了提高医疗质量，政策制定者转向了基于市场的改革，例如基于网络的质量措施公开报告和按业绩付费战略。这些举措旨在通过以下方式提高医疗保健质量：1）激励个人提供者提高其提供的护理质量; 2）通过为患者提供一种识别和选择高质量提供者的方式，增加接受高质量护理的患者数量。尽管对市场化改革的热情和这些方法的广泛采用，但这些努力是否真正提高了护理质量，以及如果确实提高了，通过何种途径。由于难以确定所观察到的医疗服务提供者质量的提高是“真正的”质量提高，还是医疗服务提供者在改革后选择更健康的病人的结果，因此质量提高的衡量变得复杂。本研究的总体目标是测试最近制定的改革是否要求公开报告在熟练的护理设施（护理之家比较）的急性后护理质量提高的护理质量。使用来自最小数据集和医疗保险索赔的数据，该项目将测量护理之家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以提高质量的两种方式：1）提高设施内部的质量，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的人口统计学特征是否与护理质量的更大变化相关，因为公共报告的养老院质量措施。目标1和目标2的分析将使用最佳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，第三个目标直接测量患者选择，并直接将这些变化与质量指标的真实变化进行比较。这将是第一次严格的分析，以告知政策辩论的好处和风险的公开报告在急性后护理部门。

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.