State and national public reporting programs operate under the assumption that the public release of healthcare information improves quality, although there is little evidence that healthcare consumers routinely use these data to make decisions. Research is necessary to create consumer-centric public reports that empower and enable consumers to access, understand and use quality data to compare providers and make choices. Consumer-centric public reports are especially timely and necessary for home health care, given state and national policies that encourage providers and payers to ensure that patients receive care in the least-restrictive setting possible. This includes shifting vulnerable patients from long-term care to community and home health services, while simultaneously implementing programs designed to reduce unnecessary healthcare utilization and lower expenditures. Taken together, these policies and the aging population are combining to significantly increase the numbers of chronically ill patients residing in the community and relying on home health services to optimize their health and health care, while lowering costs. This project will combine the expertise of researchers at Health centric Advisors and Brown University. Using focus groups, structured interviews, cognitive-based testing and a randomized, controlled trial (RCT) design, our aims are to: determine how home health consumers (patients and caregivers) and hospital case managers use the current public reporting content and format, and what changes they recommend to increase its frequency of use and decision-making utility;evaluate whether or not consumers and case managers who view a revised, consumer-centric, web-based public report understand the information and how to use it;and evaluate whether or not patients offered a new consumer-centric report prior to hospital discharge use the information to choose higher-performing home health agencies and experience better satisfaction and outcomes compared to consumers offered the old format. Our project will help to improve two of the three gaps that AHRQ has identified in the public reporting evidence base: (1) improving the design and presentation of public reports to meet the needs of consumers and (2) improving public reporting content and methodology to make reports more credible, meaningful and useful for consumer decision making. In addition to generating knowledge that can be translated to other reporting efforts, we will estimate the impact of our reporting format on home health consumers'satisfaction and outcomes, including utilization measures that have significant cost avoidance implications for state and federal policymakers.
Our findings will be relevant to public health because they provide insight into the creation of public reports that consumers can use to choose among healthcare providers, as well as the impact of these reports on consumer behavior, experiences and outcomes. If consumers use information, such as hospital readmission rates, to select better-performing home health agencies (as we hypothesize), that finding has significant implications for public health, including both patient care and policies to curb expenditures and yield cost avoidance. This is particularly important as our population ages and patients are increasingly steered towards home and community-based care, as opposed to inpatient and long-term care settings.
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