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 i s 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 i s 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. ? ? ? ?
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