Improving Nursing Home Compare for Dually Eligible Consumers

改善具有双重资格的消费者的疗养院比较

• 批准号: 8550793
• 负责人: RITA TAMARA KONETZKA
• 金额: $ 31.75万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8550793
• 关键词: Improving; Nursing; Home; Compare; Dually

DESCRIPTION (provided by applicant): Individuals who are enrolled in both Medicare and Medicaid (often called dually eligible or "duals") have attracted increased health policy attention in recent decades due to their disproportionate use of health care services and costs. Duals are a vulnerable population as they are generally sicker than the elderly population as a whole, more likely to be in need of long-term care, more likely to receive care in low-resource neighborhoods, and are subject to misaligned and conflicting policy incentives from Medicare and Medicaid. Nursing homes are a major site of care for duals. The nursing home sector has long been a target of concern about low quality of care, and duals are often disproportionately affected by these quality problems. In 2002 the Centers for Medicare and Medicaid Services launched a public reporting initiative (Nursing Home Compare) aimed at improving quality of care for nursing home residents in part by guiding consumers to higher quality nursing homes. However, studies of consumer response to Nursing Home Compare have revealed a small and inconsistent market share response. These lukewarm effects have been disappointing and somewhat puzzling, but they may be masking substantial heterogeneity of effect-duals may be much less likely to respond to, and benefit from, Nursing Home Compare than non-duals. Our preliminary work reveals that, rather than choosing higher-quality facilities, duals have increased their propensity to be admitted to low- quality facilities under public reporting. In this mixed methods project, we propose to examine the extent to which duals have benefited (or not) from Nursing Home Compare, to assess the importance of constrained access by duals in preventing greater use of Nursing Home Compare to choose higher-quality nursing homes, to assess qualitatively the obstacles to duals' use of Nursing Home Compare such that improvements to the report cards may be explored. In particular, information about the quality of nursing homes may not be helpful if an individual 1) lives too far from a high-quality home; 2) depends on Medicaid and no Medicaid beds are available in the high-quality homes; 3) has difficulty accessing or interpreting the quality information. By assessing the relative importance of barriers to effective use of Nursing Home Compare by duals, we will identify the most promising avenues for further investment, e.g. improved usability of quality reports vs improved availability of high-quality providers. These are crucial distinctions affecting access to high-quality care fora particularly vulnerable population.

描述（由申请人提供）：参加Medicare和Medicaid的个人（通常称为双重资格或“双重”）吸引了越来越多的健康政策关注 近几十年来，由于他们对医疗服务和成本的使用不成比例。双重人口是一个脆弱的人群，因为他们通常比整个老年人都病得多，更有可能需要长期护理，更有可能在低资源的社区接受护理，并且受到未对准和冲突的政策激励措施来自Medicare和Medicaid。疗养院是双重护理的主要护理场所。长期以来，疗养院行业一直是对低质量护理的关注的目标，并且双重偶数通常会受到这些质量问题的影响。 2002年，医疗保险和医疗补助服务中心发起了一项公开报告计划（疗养院比较），旨在通过指导消费者到更高质量的养老院来提高疗养院居民的护理质量。但是，对消费者对疗养院比较的反应的研究表明，市场份额不一致。这些不热的效果令人失望和令人困惑，但它们可能掩盖了二次效应的实质异质性可能比非偶数响应和受益于疗养院比较的可能性要小得多。我们的初步工作表明，双重设施并没有选择更高的设施，而是增加了 在公开报告下，他们倾向于接受低质量的设施。在这个混合方法项目中，我们建议研究双重疗养与疗养院比较（或不从中受益）的程度，以评估双重访问的限制访问的重要性，要定性地评估双重使用疗养院的障碍，以便可以探讨对成绩单的改进。特别是，有关疗养院质量的信息可能没有帮助，如果一个人1）离高品质的房屋太远； 2）取决于医疗补助，高质量的房屋中没有医疗补助床； 3）难以访问或解释质量信息。通过评估障碍对有效使用疗养院比较的相对重要性，我们将确定最有希望的进一步投资途径，例如提高了质量报告的可用性与改善的可用性 高质量的提供者。这些是影响获得高质量护理福拉的关键区别，特别是脆弱的人群。