- Title Information
- Title
- The Impact of Home Health Agency Profit Orientation and Post-Acute Care Market Competition on Patient Risk for Rehospitalization
- Name:
Personal
- Name Part
- Smith, Laura M.
- Role
- Role Term:
Text
- creator
- Origin Information
- Copyright Date
(keyDate="yes", encoding="w3cdtf")
- 2008
- Physical Description
- Extent
- xvi, 111 p.
- digitalOrigin
- born digital
- Note
- Thesis (Ph.D.) -- Brown University (2009)
- Name:
Personal
- Name Part
- Mor, Vincent
- Role
- Role Term:
Text
- director
- Name:
Personal
- Name Part
- Lapane, Kate
- Role
- Role Term:
Text
- reader
- Name:
Personal
- Name Part
- Fennell, Mary
- Role
- Role Term:
Text
- reader
- Name:
Personal
- Name Part
- Miller, Edward
- Role
- Role Term:
Text
- reader
- Name:
Corporate
- Name Part
- Brown University. Division of Biology and Medicine. Epidemiology
- Role
- Role Term:
Text
- sponsor
- Genre (aat)
- theses
- 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.
- Subject (Local)
- Topic
- health services research
- Subject (Local)
- Topic
- home health
- Subject (Local)
- Topic
- post acute care
- Subject (Local)
- Topic
- rehospitalization
- Subject (Local)
- Topic
- profit status
- Subject (FAST)
(authorityURI="http://id.worldcat.org/fast", valueURI="http://id.worldcat.org/fast/914091")
- Topic
- Epidemiology
- Subject (FAST)
(authorityURI="http://id.worldcat.org/fast", valueURI="http://id.worldcat.org/fast/959108")
- Topic
- Home care services
- Subject (FAST)
(authorityURI="http://id.worldcat.org/fast", valueURI="http://id.worldcat.org/fast/871464")
- Topic
- Competition
- Record Information
- Record Content Source (marcorg)
- RPB
- Record Creation Date
(encoding="iso8601")
- 20091218
- Language
- Language Term:
Code (ISO639-2B)
- eng
- Language Term:
Text
- English
- Identifier:
DOI
- 10.7301/Z04T6GSZ
- Access Condition:
rights statement
(href="http://rightsstatements.org/vocab/InC/1.0/")
- In Copyright
- Access Condition:
restriction on access
- Collection is open for research.
- Type of Resource (primo)
- dissertations