Regional market factors and patient experience in primary care.
Am J Manag Care
; 26(10): 438-443, 2020 10.
Article
em En
| MEDLINE
| ID: mdl-33094939
ABSTRACT
OBJECTIVES:
To evaluate the association between regional market factors and experience with patient-provider communication in primary care services of safety net hospitals. STUDYDESIGN:
A retrospective cohort study with 933,407 patient experience survey respondents from 128 Veterans Health Administration (VHA) hospitals between fiscal years 2013 and 2016.METHODS:
Patient responses on 5 patient-provider communication questions were used to evaluate quality of care. Six regional market factors were used to characterize veterans' health care insurance coverage and affluence. A logistic regression was used to examine changes in individual-level patient-provider communication experience when regional market factors increase or decrease the demand for VHA primary care services.RESULTS:
Our findings supported our hypothesis that changes in regional market factors shift patient demand for VHA care and affect patient-provider communication measured by patient experience surveys. The adjusted odds ratio (AOR) of positive patient-provider communication was associated with a regional increase (first to third quartile) of employer-sponsored insurance (AOR, 1.028; 95% CI, 1.001-1.055) and a decrease (third to first quartile) in the veterans' unemployment rate (AOR, 0.966; 95% CI, 0.944-0.990). Higher primary care capacity (first to third quartile) was also associated with positive patient-provider communication (AOR, 1.050; 95% CI, 1.018-1.082).CONCLUSIONS:
Findings from this study raise concerns that safety net hospitals could be unfairly penalized by value-based payment programs and Medicare Hospital Compare. Such policies and programs could improve resource allocation by accounting for regional market factors before acting on quality of care measures.
Texto completo:
1
Coleções:
01-internacional
Contexto em Saúde:
11_ODS3_cobertura_universal
Base de dados:
MEDLINE
Assunto principal:
Atenção Primária à Saúde
/
Veteranos
/
Medicare
/
Avaliação de Resultados da Assistência ao Paciente
Tipo de estudo:
Observational_studies
Limite:
Aged
/
Humans
/
Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Am J Manag Care
Ano de publicação:
2020
Tipo de documento:
Article