Shetty Kanaka D, Robbins Michael W, Saliba Debra, Campbell Kyle N, Castora-Binkley Melissa, Damberg Cheryl L
RAND Corporation, Santa Monica, California, USA.
RAND Corporation, Pittsburgh, Pennsylvania, USA.
J Am Geriatr Soc. 2021 Nov;69(11):3273-3284. doi: 10.1111/jgs.17368. Epub 2021 Aug 6.
The Centers for Medicare & Medicaid Services (CMS) Home Health Quality Reporting Program (HHQRP) uses performance measurement to spur improvements in home health agencies' (HHAs') quality of care. We examined quality improvement (QI) activities HHAs reported making to improve on HHQRP quality measures, and whether reported QI activities were associated with better measure performance.
We used responses (N = 1052) from a Web- and mail-based survey of a stratified random sample of HHAs included in CMS Home Health Compare in October 2019. We estimated national adoption rates for 27 possible QI activities related to organizational culture, health information technology, care process redesign, provider incentives, provider training, changes to staffing responsibilities, performance monitoring, and measure-specific QI initiatives and technical assistance. We used multivariate linear regression to examine the associations between HHA characteristics and QI adoption, and between QI adoption and CMS Home Health Quality of Patient Care Star Rating.
HHAs reported implementing an average of 16 QI activities (interquartile range 11-19 activities). Larger HHA size was associated with adopting 1.6 additional QI activities (p < 0.001). HHAs with higher proportions of disabled, black, or Hispanic patients adopted QI activities at similar or higher rates as other HHAs. Of the 27 QI activities, 23 were considered helpful by more than 80% of adopting HHAs. Compared with adopting 44% of QI activities (10th percentile among HHAs), adopting 89% of QI activities (90th percentile) was associated with a 0.4-star higher Star Rating (95% confidence interval 0.2-0.6).
HHAs report implementing a significant number of QI activities in response to CMS measurement programs; implementation of a greater number of activities is associated with better performance on publicly reported measures. To guide future HHA QI investments, work is needed to identify the optimal combination of QI activities and the specific QI activities that yield the greatest performance improvements.
医疗保险和医疗补助服务中心（CMS）的家庭健康质量报告计划（HHQRP）利用绩效评估来推动家庭健康机构（HHA）提高护理质量。我们研究了HHA报告的为改进HHQRP质量指标而开展的质量改进（QI）活动，以及报告的QI活动是否与更好的指标表现相关。
我们使用了对2019年10月CMS家庭健康比较中纳入的HHA分层随机样本进行的基于网络和邮件的调查的回复（N = 1052）。我们估计了与组织文化、健康信息技术、护理流程重新设计、提供者激励、提供者培训、人员职责变更、绩效监测以及特定指标的QI举措和技术援助相关的27种可能的QI活动的全国采用率。我们使用多元线性回归来研究HHA特征与QI采用之间的关联，以及QI采用与CMS患者护理星级评定的家庭健康质量之间的关联。
HHA报告平均实施了16项QI活动（四分位间距为11 - 19项活动）。较大规模的HHA与多采用1.6项QI活动相关（p < 0.001）。残疾患者、黑人患者或西班牙裔患者比例较高的HHA采用QI活动的比例与其他HHA相似或更高。在27项QI活动中，超过80%采用该活动的HHA认为23项活动有帮助。与采用44%的QI活动（HHA中的第10百分位数）相比，采用89%的QI活动（第90百分位数）与星级评定高出0.4星相关（95%置信区间为0.2 - 0.6）。
HHA报告称，为响应CMS测量计划实施了大量QI活动；实施更多活动与公开报告指标上的更好表现相关。为指导未来HHA的QI投资，需要开展工作以确定QI活动的最佳组合以及能带来最大绩效提升的特定QI活动。
