Schulich School of Business, York University, Toronto, ON, Canada.
Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, CT.
Med Care. 2019 Jan;57(1):28-35. doi: 10.1097/MLR.0000000000001016.
To enhance the quality of hospice care and to facilitate consumers' choices, the Centers for Medicare and Medicaid Services (CMS) began the Hospice Quality Reporting Program, in which CMS posted the quality measures of participating hospices on its reporting website, Hospice Compare. Little is known about the participation rate and the types of nonparticipating hospices.
To examine the factors associated with hospices' nonparticipation in Hospice Compare.
We analyzed data from the CMS 2016 Hospice Compare. "Nonparticipants" were those who did not submit any quality measure. With the data of the Provider of Service file, the Healthcare Cost Report Information System, and the Area Health Resources File, multivariate logistic regressions estimated the association between nonparticipants and hospice and market characteristics, including ownership, size, nurse staffing ratio, and market competition intensity.
Among the 4123 certified hospices subject to penalty from nonparticipation, 259 did not participate in Hospice Compare. California, New Mexico, Texas, and Wyoming had participation rates lower than 80%. Hospices that were for-profit, had no accreditation, had few nurses per patient day, provided no inpatient care, and were located in competitive markets were less likely to participate than other hospices.
Hospice Compare successfully motivated hospice in participating in the quality report program in most of states. For-profit hospices, hospices with less quality, and hospices located in competitive markets were less likely to participate. Further research is warranted to examine the quality of these nonparticipants, especially in the 4 states with a lower participation rate.
为提高临终关怀质量，方便消费者选择，医疗保险和医疗补助服务中心（CMS）启动了临终关怀质量报告计划，在该计划中，CMS 将参与临终关怀机构的质量指标发布在其报告网站 Hospice Compare 上。人们对参与率和不参与的临终关怀机构类型知之甚少。
探讨与临终关怀机构不参与 Hospice Compare 相关的因素。
我们分析了 CMS 2016 年 Hospice Compare 的数据。“不参与者”是指未提交任何质量指标的机构。利用服务提供者档案、医疗保健成本报告信息系统和区域卫生资源档案的数据，多变量逻辑回归估计了不参与者与临终关怀机构和市场特征（包括所有权、规模、护士人员配备比例和市场竞争强度）之间的关联。
在因不参与而受到处罚的 4123 家认证临终关怀机构中，有 259 家未参与 Hospice Compare。加利福尼亚州、新墨西哥州、得克萨斯州和怀俄明州的参与率低于 80%。营利性、没有认证、每位患者每天护士人数少、不提供住院护理以及位于竞争激烈市场的临终关怀机构参与率较低。
Hospice Compare 成功地促使大多数州的临终关怀机构参与质量报告计划。营利性临终关怀机构、质量较低的临终关怀机构和位于竞争激烈市场的临终关怀机构参与度较低。有必要进一步研究这些不参与者的质量，特别是在参与率较低的 4 个州。
