发表机构
Gwinnett Technical College; MeSun Hospice（格威内特技术学院; 美松临终关怀医院）
机构由 AI 辅助整理，请以论文原文为准。AI 中文总结
本研究构建提供者-县绩效评估框架，发现加入县级背景显著提升临终关怀质量评估准确性，但营利性机构照护者评分仍低于非营利性机构，且社会脆弱性影响照护者体验，支持情境化监测与改进。
AI 中文摘要
临终关怀质量应结合提供者组织和提供照护的当地条件来解读。本研究通过将国家医疗保险和医疗补助服务中心（CMS）临终关怀数据以及医疗提供者与系统消费者评估（CAHPS）临终关怀调查结果与县级农村化程度、社会脆弱性、健康负担以及劳动力和健康资源背景指标相关联，构建了一个提供者-县绩效评估框架。调整后分析包括1,078个县的2,928家提供者，并结合了地理映射、分块回归、六个次要CAHPS结果和八项敏感性分析。加入县级背景后，调整后的R平方从0.077增加到0.202。经过全面调整后，营利性临终关怀机构的整体照护者评分比非营利性机构低3.832个百分点。这种负相关在所有六个次要CAHPS领域中出现，并在每个敏感性规格中保持显著。较高的县级社会脆弱性也与较差的照护者体验相关，尽管其影响程度部分取决于社区健康负担的规格。这些发现表明，县级背景实质上改善了临终关怀绩效评估，但并未消除所有权差异。该框架支持情境感知监测、同行比较和有针对性的质量改进。
英文摘要
Hospice quality should be interpreted in relation to both provider organization and the local conditions under which care is delivered. This study develops a provider-county performance assessment framework by linking national Centers for Medicare & Medicaid Services (CMS) hospice data and Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey outcomes with county measures of rurality, social vulnerability, health burden, and workforce and health-resource context. The adjusted analysis includes 2,928 providers in 1,078 counties and combines geographic mapping, blockwise regression, six secondary CAHPS outcomes, and eight sensitivity analyses. Adding county context increased adjusted R-squared from 0.077 to 0.202. After full adjustment, for-profit hospices had overall caregiver ratings 3.832 percentage points lower than nonprofit hospices. This negative association appeared across all six secondary CAHPS domains and remained significant in every sensitivity specification. Higher county social vulnerability was also associated with poorer caregiver experience, although its magnitude depended partly on the specification of community health burden. These findings show that county context materially improves hospice performance assessment but does not eliminate the ownership difference. The framework supports context-aware monitoring, peer comparison, and targeted quality improvement.
Comments35 pages, 5 figures, 7 tables. Submitted to Health Care Management Science
