<mods:mods xmlns:mods="http://www.loc.gov/mods/v3" xmlns:METS="http://www.loc.gov/METS/" xmlns:fits="http://hul.harvard.edu/ois/xml/ns/fits/fits_output" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:IR="http://dl.lib.brown.edu/md/irdata" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:rights="http://cosimo.stanford.edu/sdr/metsrights/" ID="etd167">
<mods:titleInfo>
<mods:title>The Impact of Home Health Agency Profit Orientation and Post-Acute Care Market Competition on Patient Risk for Rehospitalization</mods:title>
</mods:titleInfo>
<mods:name type="personal">
<mods:namePart>Smith, Laura M.</mods:namePart>
<mods:role>
<mods:roleTerm type="text">creator</mods:roleTerm>
</mods:role>
</mods:name>
<mods:originInfo>
<mods:copyrightDate keyDate="yes" encoding="w3cdtf">2008</mods:copyrightDate>
</mods:originInfo>
<mods:physicalDescription>
<mods:extent>xvi, 111 p.</mods:extent>
<mods:digitalOrigin>born digital</mods:digitalOrigin>
</mods:physicalDescription>
<mods:note>Thesis (Ph.D.) -- Brown University (2009)</mods:note>
<mods:name type="personal">
<mods:namePart>Mor, Vincent</mods:namePart>
<mods:role>
<mods:roleTerm type="text">director</mods:roleTerm>
</mods:role>
</mods:name>
<mods:name type="personal">
<mods:namePart>Lapane, Kate</mods:namePart>
<mods:role>
<mods:roleTerm type="text">reader</mods:roleTerm>
</mods:role>
</mods:name>
<mods:name type="personal">
<mods:namePart>Fennell, Mary</mods:namePart>
<mods:role>
<mods:roleTerm type="text">reader</mods:roleTerm>
</mods:role>
</mods:name>
<mods:name type="personal">
<mods:namePart>Miller, Edward</mods:namePart>
<mods:role>
<mods:roleTerm type="text">reader</mods:roleTerm>
</mods:role>
</mods:name>
<mods:name type="corporate">
<mods:namePart>Brown University. Division of Biology and Medicine. Epidemiology</mods:namePart>
<mods:role>
<mods:roleTerm type="text">sponsor</mods:roleTerm>
</mods:role>
</mods:name>
<mods:genre authority="aat">theses</mods:genre>
<mods: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.</mods:abstract>
<mods:subject authority="local">
<mods:topic>health services research</mods:topic>
</mods:subject>
<mods:subject authority="local">
<mods:topic>home health</mods:topic>
</mods:subject>
<mods:subject authority="local">
<mods:topic>post acute care</mods:topic>
</mods:subject>
<mods:subject authority="local">
<mods:topic>rehospitalization</mods:topic>
</mods:subject>
<mods:subject authority="local">
<mods:topic>profit status</mods:topic>
</mods:subject>
<mods:subject authority="FAST" authorityURI="http://id.worldcat.org/fast" valueURI="http://id.worldcat.org/fast/914091"><mods:topic>Epidemiology</mods:topic></mods:subject><mods:subject authority="FAST" authorityURI="http://id.worldcat.org/fast" valueURI="http://id.worldcat.org/fast/959108"><mods:topic>Home care services</mods:topic></mods:subject><mods:subject authority="FAST" authorityURI="http://id.worldcat.org/fast" valueURI="http://id.worldcat.org/fast/871464"><mods:topic>Competition</mods:topic></mods:subject><mods:recordInfo>
<mods:recordContentSource authority="marcorg">RPB</mods:recordContentSource>
<mods:recordCreationDate encoding="iso8601">20091218</mods:recordCreationDate>
</mods:recordInfo>
<mods:language><mods:languageTerm type="code" authority="iso639-2b">eng</mods:languageTerm><mods:languageTerm type="text">English</mods:languageTerm></mods:language><mods:identifier type="doi">10.7301/Z04T6GSZ</mods:identifier><mods:accessCondition type="rights statement" xlink:href="http://rightsstatements.org/vocab/InC/1.0/">In Copyright</mods:accessCondition><mods:accessCondition type="restriction on access">Collection is open for research.</mods:accessCondition><mods:typeOfResource authority="primo">dissertations</mods:typeOfResource></mods:mods>