Adjusting home health rankings by proprietary status, to assist patients select quality services

Patients evaluate the quality of home health services (HHAs) using the HCAHPS survey. The Centers for Medicare and Medicaid Services (CMS) publishes these ratings, using a five-star system. There are three types of HHAs, according to their proprietary status: governmental, non-profit and for-profit. The objective of this study is to, first measure differences of patient ratings between the three proprietary types, then construct an updated ranking, adjusted to the proprietary status, and finally develop a pilot interface to assist patients and their caregivers compare and choose high quality service. Five HCAHPS indicators were selected: summary rating, quality of patient care, professional care, communication and percent of patients who would recommend the agency to friends and family. Governmental and for-profit agencies received the highest and lowest summary ratings respectively (85.7% vs 53.3% were rated with four or five stars). Multiple comparisons with post hoc ANOVA analysis, revealed statistically significant differences for the majority of ratings, between and within the three different types of home health agencies (p <0.001). Since patients are often limited to agencies of a specific proprietary status, adjusted ratings comparing agencies to counterparts of same proprietary status, were constructed, and incorporated into a pilot interface. The interface will allow patients compare the original and adjusted ratings for specific HHAs of interest, or search by State, and zip code. Patients will therefore have a more realistic picture on how an agency stacks up against other candidates of same proprietary status, in an effort to choose optimal HH service.