Description
- Abstract:
- Little recent research exists identifying home health agency (HHA) organizational and market characteristics that influence home health quality. This study, grounded in organizational sociology, had four objectives. First, using a nationally representative sample survey, I quantified the impact of HHA profit orientation on quality, measured as patient risk for hospitalization within 60 days of agency admission. For the remaining objectives I used a census of Medicare Home Health beneficiaries aged 65 and older receiving care from free-standing HHA and 2) quantified the impact of HHA profit orientation and 3) post-acute market competition on post-acute care patients' risk for rehospitalization within 60 days of home health admission. Lastly, 4) I determined if the effect of HHA profit status varied by market competition. I hypothesized patients receiving care from for-profit agencies were at higher risk because differences in organizational mission as influenced by agencies' obligations to key-resource suppliers. For-profits might sacrifice quality in pursuit of profits for share-holders. Results for profit status showed no effect of profit status. For objective 1 I used propensity score adjusted, weighted polytomous logistic regression, which allowed competing risks for death or discharge to nursing home and for objective 2, I conducted multilevel logistic regressions, which controlled for clustering of patients within HHA. My findings suggest no difference in the quality of care provided to patients by for-profit and not-for-profit HHAs. Increased competition, reimbursement policy changes, and public reporting may have influenced agencies to behave similarly, resulting in similar levels of quality. For the market-competition analyses, I hypothesized that patients receiving care from agencies in non-competitive and highly competitive markets would have higher risks than patients in moderately competitive markets, and that the effect of profit-status on patient risk would differ over levels of market competition. I observed no effect of market competition, nor was the effect of profit status impacted by market competition. Our market-level results suggested that variation in rehospitalization among free-standing HHAs, may be driven more by regional practice patterns and propensity to utilize inpatient care than by competition.
- Notes:
- Thesis (Ph.D.) -- Brown University (2009)
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Citation
Smith, Laura M.,
"The Impact of Home Health Agency Profit Orientation and Post-Acute Care Market Competition on Patient Risk for Rehospitalization"
(2008).
Epidemiology Theses and Dissertations, Biology and Medicine Theses and Dissertations.
Brown Digital Repository. Brown University Library.
https://doi.org/10.7301/Z04T6GSZ
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Biology and Medicine Theses and Dissertations
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