title: A qualitative study of choosing home health care after hospitalization: the unintended consequences of 'patient choice' requirements.
abstract: BACKGROUND
  Although hospitals are increasingly held accountable for patients' post-discharge outcomes, giving them incentive to help patients choose high-performing home health agencies, little is known about how quality reports inform decision making.
  
  
  OBJECTIVE
  We aimed to learn how quality reports are used when choosing home care in one northeast state (Rhode Island) .
  
  
  METHODS
  The study consisted of focus groups with home health consumers and structured interviews with hospital case managers.
  
  
  METHODS
  Thirteen consumers and 28 case managers from five hospitals participated in the study.
  
  
  METHODS
  We identified key themes and illustrative quotes by audiotaping each session, and then three independent reviewers conducted repeated examination and content analysis.
  
  
  RESULTS
  No participants were aware of existing state or Medicare home health agency public reports. Case managers provided agency lists to consumers, who routinely asked case managers to tell them which agencies to choose or which were best; but case managers felt unable to directly respond to consumers' requests for help in making the choice, because they did not have additional information to provide and because they feared violating federal laws requiring freedom of patient choice. Case managers also felt that there was little difference in agency quality, although they acknowledged they might not be aware of problems related to post-hospital care.
  
  
  CONCLUSIONS
  Home health consumers and hospital case managers were unaware of public reports about home health quality, which limited consumers' ability to make informed decisions and case managers' ability to assist them in that decision-making process. Case managers were otherwise prohibited from recommending specific providers to patients and viewed the 'patient choice' laws as restricting their ability to respond to patients' requests for help in choosing home health agencies. Public reports can be marketed as tools that case managers can use to help patients differentiate among providers, while supporting patient autonomy.
authors.affiliation: Healthcentric Advisors, Providence, RI, 02908, USA, rosa_baier@brown.edu.
authors.forename: Rosa R
authors.initials: RR
authors.lastname: Baier
authors.forename: Andrea
authors.initials: A
authors.lastname: Wysocki
authors.forename: Stefan
authors.initials: S
authors.lastname: Gravenstein
authors.forename: Emily
authors.initials: E
authors.lastname: Cooper
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
authors.forename: Melissa
authors.initials: M
authors.lastname: Clark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003657:Decision Making; D005260:Female; D017144:Focus Groups; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D006278:Medicare; D010351:Patient Discharge / Q000706:statistics & numerical data*; D057240:Patient Preference / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012237:Rhode Island; D014481:United States