title: Home health agency profit orientation and risk for hospitalization: a propensity score analysis of population weighted data.
abstract: Little recent research exists identifying home health agency (HHA) organizational characteristics that influence home health quality. This study evaluates the impact of HHA profit orientation on quality, measured as patient risk for hospitalization within 60 days of agency admission. Our sample (n = 1,304), from the National Home and Hospice Care Survey, comprised noninstitutionalized patients, 18 and older, including all payer types, discharged from free-standing HHAs. Our most deconfounded estimate, derived by propensity score adjusted, weighted polytomous logistic regression, yielded a for-profit hospitalization odds ratio of 1.31 but with a large confidence interval including unity. Results do not support our hypothesis of higher hospitalization risk for for-profit HHA patients.
authors.affiliation: Department of Community Health, Warren Alpert Medical School, Brown University, Box G-S1211-6, Providence, RI 02912, USA. Laura_Smith@brown.edu
authors.forename: Laura M
authors.initials: LM
authors.lastname: Smith
authors.forename: Kate L
authors.initials: KL
authors.lastname: Lapane
authors.forename: Mary L
authors.initials: ML
authors.lastname: Fennell
authors.forename: Edward A
authors.initials: EA
authors.lastname: Miller
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006269:Health Facilities, Proprietary / Q000458:organization & administration*; D006302:Health Services Research; D018574:Home Care Agencies / Q000458:organization & administration*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D015401:Nursing Administration Research; D009735:Nursing Homes / Q000458:organization & administration; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010067:Ownership / Q000458:organization & administration*; D010343:Patient Admission / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration*; D018570:Risk Assessment; D014837:Voluntary Health Agencies / Q000458:organization & administration*