干旱区生态环境知识资源中心(Arid): Quality of Home Health Agencies Serving Traditional Medicare vs Medicare Advantage Beneficiaries

Arid

DOI	10.1001/jamanetworkopen.2019.10622
	Quality of Home Health Agencies Serving Traditional Medicare vs Medicare Advantage Beneficiaries
	Schwartz, Margot L.; Kosar, Cyrus M.; Mroz, Tracy M.; Kumar, Amit; Rahman, Momotazur
通讯作者	Rahman, M (corresponding author), Brown Univ, Sch Publ Hlth, Dept Hlth Serv Policy & Practice, 121 S Main St,POB G-S121-6, Providence, RI 02912 USA.
来源期刊	JAMA NETWORK OPEN
ISSN	2574-3805
出版年	2019
卷号	2 期号:9
英文摘要	IMPORTANCE Medicare Advantage (MA) enrollment is increasing, with one-third of Medicare beneficiaries currently selecting MA. Despite this growth, it is difficult to assess the quality of the health care professionals and organizations that serve MA beneficiaries or to compare them with health care professionals and organizations serving traditional Medicare (TM) beneficiaries. Elderly individuals served by home health agencies (HHAs) may be particularly susceptible to the negative outcomes associated with low-quality care. OBJECTIVE To compare the quality of HHAs that serve TM and MA beneficiaries. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, admission-level analysis used data from 4 391 980 home health admissions identified using the Outcome and Assessment Information Set (most commonly known as OASIS) admission assessments of Medicare beneficiaries in 2015 from Medicare-certified HHAs. A multinomial logistic regression model was used to assess whether an association existed between the Medicare plan type and HHA quality. The model was adjusted for patient demographics, acuity, and characteristics of the zip codes. Sensitivity analyses controlled for zip code fixed effects. The present analysis was conducted between October 2018 and March 2019. EXPOSURES Home health users were classified as TM or MA beneficiaries using the Master Beneficiary Summary File. The MA beneficiaries were further classified as enrolled in a high-or low-quality MA plan on the basis of publicly reported MA star ratings. MAIN OUTCOMES AND MEASURES Quality of HHA derived from the publicly reported patient care star ratings: low quality (1.0-2.5 stars), average quality (3.0-3.5 stars), or high quality (>= 4.0 stars). RESULTS Of 4 391 980 admissions, most (75.5%) were for TM beneficiaries (mean [SD] age, 76.1 [12.2] years), with 16.6% of beneficiaries enrolled in high-quality MA plans (mean [SD] age, 77.8 [10.0] years) and 7.9% in low-quality MA plans (mean [SD] age, 74.4 [11.4] years). Individuals enrolled in low-rated MA plans were most likely to be non white (percentages of non white individuals in TM, 14.3%; in high-quality MA, 19.8%; and in low-quality MA, 36.5%) and dual Medicare-Medicaid eligible (percentages for dual eligible in TM, 30.5%; in high-quality MA, 19.5%; and in low-quality MA, 43.3%). Among TM beneficiaries, 30.4% received care from high-quality HHAs, whereas 17.0% received care from low-quality HHAs. Compared with TM beneficiaries, those in a low-quality MA plan were 3.0 percentage points (95% CI, 2.6%-3.4%) more likely to be treated by a low-quality HHA and 4.9 percentage points (95% CI, -5.4% to -4.3%) less likely to be treated by a high-quality HHA. The MA beneficiaries in high-quality plans were also less likely to receive care from high-quality vs low-quality HHAs (-2.8%[95% CI, -3.1% to -2.2%] vs 1.0% [95% CI, 0.7%-1.3%]). CONCLUSIONS AND RELEVANCE Compared with TM beneficiaries, MA beneficiaries residing in the same zip code enrolled in either high- or low-quality MA plans may receive treatment from lower-quality HHAs. Policy makers may consider incentivizing MA plans to include higher-quality HHAs in their networks and improving patient education regarding HHA quality.
类型	Article
语种	英语
开放获取类型	Green Published, gold
收录类别	SCI-E
WOS记录号	WOS:000488882800008
WOS关键词	OUTCOMES ; ENROLLEES ; CARE
WOS类目	Medicine, General & Internal
WOS研究方向	General & Internal Medicine
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/369832
作者单位	[Schwartz, Margot L.; Kosar, Cyrus M.; Rahman, Momotazur] Brown Univ, Sch Publ Hlth, Hlth Serv Policy & Practice, Providence, RI 02912 USA; [Mroz, Tracy M.] Univ Washington, Rehabil Med, Seattle, WA 98195 USA; [Kumar, Amit] No Arizona Univ, Phys Therapy, Phoenix, AZ USA
推荐引用方式 GB/T 7714	Schwartz, Margot L.,Kosar, Cyrus M.,Mroz, Tracy M.,et al. Quality of Home Health Agencies Serving Traditional Medicare vs Medicare Advantage Beneficiaries[J],2019,2(9).
APA	Schwartz, Margot L.,Kosar, Cyrus M.,Mroz, Tracy M.,Kumar, Amit,&Rahman, Momotazur.(2019).Quality of Home Health Agencies Serving Traditional Medicare vs Medicare Advantage Beneficiaries.JAMA NETWORK OPEN,2(9).
MLA	Schwartz, Margot L.,et al."Quality of Home Health Agencies Serving Traditional Medicare vs Medicare Advantage Beneficiaries".JAMA NETWORK OPEN 2.9(2019).