Claims-Based vs Agency-Reported Patient Outcomes Among Home Health Agencies, 2013-2019.
JAMA Netw Open
; 7(4): e245692, 2024 Apr 01.
Article
in En
| MEDLINE
| ID: mdl-38598240
ABSTRACT
Importance Given the growth of home health agency (HHA) care, it is important to understand whether quality reporting programs, such as star ratings, are associated with improved patient outcomes. Objective:
To assess the immediate and long-term association of the introduction of HHA star ratings with patient-level quality outcomes, comparing claims-based and agency-reported measures. Design, Setting, andParticipants:
This cross-sectional study used Medicare HHA claims and agency-reported assessments to identify sequential patient episodes (ie, spells) among US adults with traditional Medicare who received HHA care (2013-2019). An interrupted time series (ITS) model was used to measure changes in trends and levels before and after the introduction of star ratings. Statistical analysis was performed from November 2022 to September 2023. Exposure The exposure was the introduction of HHA star ratings. The postexposure period was set as starting January 1, 2016, to account for the period when both star ratings (quality of patient care and patient satisfaction rating) were publicly reported. Main Outcomes andMeasures:
The main outcomes included claims-based hospitalization measures (both during the patient spell and 30 days after HHA discharge) and agency-reported functional measures, such as improvement in ambulation, bathing, and bed transferring. There was also a measure to capture timely initiation of care among post-acute care HHA users, defined as HHA care initiated within 2 days of inpatient discharge.Results:
This study identified 22â¯958â¯847 patient spells to compare annual changes over time; 9â¯750â¯689 patient spells were included during the pre-star ratings period from January 1, 2013, to December 31, 2015 (6â¯067â¯113 [62.2%] female; 1â¯100â¯145 [11.3%] Black, 512â¯487 [5.3%] Hispanic, 7â¯845â¯197 [80.5%] White; 2â¯656â¯124 [27.2%] dual eligible; mean [SD] patient spell duration, 70.9 [124.9] days; mean [SD] age, 77.4 [12.0] years); 13â¯208â¯158 patient spells were included during the post-star ratings period from January 1, 2016, to December 31, 2019 (8â¯104â¯69 [61.4%] female; 1â¯385â¯180 [10.5%] Black, 675â¯536 [5.1%] Hispanic, 10â¯664â¯239 [80.7%] White; 3â¯318â¯113 [25.1%] dual eligible; mean [SD] patient spell duration, 65.3 [96.2] days; mean [SD] age, 77.7 [11.6] years). Results from the ITS models found that the introduction of star ratings was associated with an acceleration in the mean [SE] hospitalization rate during the spell (0.39% [0.05%] per year) alongside functional improvements in ambulation (2.40% [0.29%] per year), bed transferring (3.95% [0.48%] per year) and bathing (2.34% [0.19%] per year) (P < .001). This occurred alongside a 1.21% (0.12%) per year reduction in timely initiation of care (P < .001). Conclusions and Relevance This cross-sectional study found an observed improvement in agency-reported functional measures, which contrasted with slower increases in more objective measures such as hospitalization rates and declines in timely initiation of care. These findings suggest a complex picture of HHA quality of care after the introduction of star ratings.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Blood Group Antigens
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Home Care Agencies
Limits:
Adult
/
Aged
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Female
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Humans
/
Male
Country/Region as subject:
America do norte
Language:
En
Journal:
JAMA Netw Open
Year:
2024
Document type:
Article
Country of publication: