The Impact of Human Service Provider Quality on the Personal Outcomes of People With Intellectual and Developmental Disabilities

BackgroundQuality of life is multidimensional—influenced by individual, organizational, and environmental factors. As such, when examining personal outcomes, it is also important to consider meso and macro factors that contribute to people with intellectual and developmental disabilities' (IDD's) quality of life. While it is widely acknowledged that organizational factors contribute to people's quality of life, there is less research directly examining how the quality of human service providers contributes to people with IDD's personal outcomes. For these reasons, the aim of this study was to explore the relationship between provider quality and people with IDD's personal quality of life outcomes.MethodsUsing a multilevel linear regression we analyzed secondary Personal Outcome Measures® (personal outcomes) and Basic Assurances® (provider quality) data from 2,900 people with IDD served by 331 human service providers.ResultsPeople with IDD's personal outcomes, regardless of their support needs or other demographics, were significantly impacted by the quality of the human service providers they received services from—the higher the quality of the provider, the more personal outcomes they had present. In addition, the following demographic covariates were correlated with personal outcomes: gender; race; complex support needs; residence type; and organizations that offered therapy services.DiscussionWhile quality improvement initiatives may require a great deal of cost and time commitment from providers, our findings suggest the effort translates to improved personal outcomes among people with IDD. The ultimate goal of service providers should be improvement of quality of life among those they support.

Influence of social determinants of health on oncology care quality rankings.

139 Background: Adjustment for social determinants of health (SDOH) when assessing provider care quality remains limited. The Oncology Care Model (OCM), for example, includes low-income status/dual eligibility (LIS/DE) as a part of the risk adjustment model for some quality measures, but does not account for any social risk variables in the hospice measure. No measures within the OCM account for additional social risk factors beyond LIS/DE such as patients’ race, rurality, and social deprivation. Additional SDOH adjustment could increase the accuracy of provider quality rankings and better align performance-based payments with true provider quality. Methods: North Carolina Medicare claims from 2015-2017 comprised the data for this study. The year 2015 was used to establish baseline covariates. Episodes were attributed to physician practices’ Tax Identification Number (TIN), lasted 6 months, and were divided into performance years beginning 1/1/2016 and 7/1/2016. Three measures were used: 1) all-cause hospital admissions; 2) all-cause emergency department visits or observation stays; and 3) admission to hospice for 3 days or more among patients who died. SDOH included patient-level race as well as county-level rurality and social deprivation, measured using the social deprivation index (SDI). TIN-level scores with and without expanded SDOH variables were divided into quintiles and compared descriptively as well as using weighted kappa statistics. Results: No SDOH were significantly associated with the hospitalization outcome (P = 0.118-0.944). For the ED measure, Black patients and rural patients were significantly more likely to have an ED visit or observation stay during an episode than white patients and urban patients (P < 0.0001). For the hospice measure, greater SDI values were associated with less hospice use (P < 0.05). Accordingly, including SDOH variables for ED visit/observation stay and hospice measures had a greater impact on TIN rankings than for the hospitalization measure (Table). Conclusions: Because quintile rankings in determine potential shared savings under models like the OCM, differences in rankings due to additional SDOH variables could have a meaningful impact on TIN-level revenue. Additional work is needed to expand the scope of patient-level SDOH variables used for risk adjustment and to explore differences across TINs which contribute to SDOH-sensitive changes in rankings.[Table: see text]

Impact of imprecise household location on effective coverage estimates generated through linking household and health provider data by geographic proximity: a simulation study

Background Geographic proximity is often used to link household and health provider data to estimate effective coverage of health interventions. Existing household surveys often provide displaced data on the central point within household clusters rather than household location. This may introduce error into analyses based on the distance between households and providers. Methods We assessed the effect of imprecise household location on quality-adjusted effective coverage of child curative services estimated by linking sick children to providers based on geographic proximity. We used data on care-seeking for child illness and health provider quality in Southern Province, Zambia. The dataset included the location of respondent households, a census of providers, and data on the exact outlets utilized by sick children included in the study. We displaced the central point of each household cluster point five times. We calculated quality-adjusted coverage by assigning each sick child to a provider’s care based on three measures of geographic proximity (Euclidean distance, travel time, and geographic radius) from the household location, cluster point, and displaced cluster locations. We compared the estimates of quality-adjusted coverage to each other and estimates using each sick child’s true source of care. We performed sensitivity analyses with simulated preferential care-seeking from higher-quality providers and randomly generated provider quality scores. Results Fewer children were linked to their true source of care using cluster locations than household locations. Effective coverage estimates produced using undisplaced or displaced cluster points did not vary significantly from estimates produced using household location data or each sick child’s true source of care. However, the sensitivity analyses simulating greater variability in provider quality showed bias in effective coverage estimates produced with the geographic radius and travel time method using imprecise location data in some scenarios. Conclusions Use of undisplaced or displaced cluster location reduced the proportion of children that linked to their true source of care. In settings with minimal variability in quality within provider categories, the impact on effective coverage estimates is limited. However, use of imprecise household location and choice of geographic linking method can bias estimates in areas with high variability in provider quality or preferential care-seeking.

Experiences of Burnout Among Nurse Anesthetists

Recent and mounting evidence indicates burnout among healthcare providers in the United States has been steadily rising over the last decade. Review of the literature has indicated that burnout affects provider clinical performance, professionalism, quality, incidence of medical errors, and intention to stay in the profession. Burnout has been shown to impact provider quality of life. However, education focused on coping skills can reduce burnout amongst providers. This article describes a quality improvement project conducted to determine the effect of a burnout awareness and coping skills program to decrease burnout among nurse anesthetists at a level one trauma center. The educational program provided information that helped staff to identify signs and symptoms of burnout and offered strategies to reduce burnout. We describe the project methods, and results, which suggested a significant decrease in participants’ levels of the emotional exhaustion component of burnout following participation in the program. We offer discussion about the clinical significance of our findings, note project limitations, and conclude with implications for research and practice.

Impact of Imprecise Household Location on Effective Coverage Estimates Generated through Linking Household and Health Provider Data by Geographic Proximity

Background: Combining household and health provider data can be used to estimate coverage of interventions and identify barriers to use. Without data on specific sources of care utilized by individuals, researchers often assign individuals to healthcare providers based on geographic proximity. The Demographic and Health Survey (DHS), a common source of population health data, does not collect data on the location of participant households. They present displaced data on the central point within household clusters. This may introduce error into analyses based on the distance between households and providers. Methods: We assessed the effect of imprecise household location on quality-adjusted effective coverage of child curative services estimated by linking sick children to providers based on geographic proximity. We used data on care-seeking for child illness and health provider quality in Southern Province, Zambia. The dataset included the location of respondent households, a census of providers, and data on the exact outlets utilized by sick children included in the study. We displaced the central point of each household cluster point five times. We calculated quality-adjusted coverage by assigning each sick child to a provider’s care based on three measures of geographic proximity (absolute distance, travel time, and geographic radius) from the household location, cluster point, and displaced cluster locations. We compared the estimates of quality-adjusted coverage to each other and estimates calculated using each sick child’s true source of care. Results: Fewer children were linked to their true source of care using cluster locations than household locations. Estimates of coverage were not statistically different using different measures of geographic proximity or household location. Estimates did not vary significantly from estimates produced using each sick child’s true source of care. Conclusions: Use of original or displaced cluster location did not produce statistically different coverage estimates than using household location. However, it did reduce the proportion of children that linked to their true source of care. The limited effect of household location imprecision on quality-adjusted coverage estimates could be due to a lack of variability in provider quality. These findings may not hold in a setting with more considerable variation in provider quality. This work was supported by the Bill & Melinda Gates Foundation, Grant Number INV-006966

Choice, quality and patients’ experience: evidence from a Finnish physiotherapy service

We study the relationship between patient choices and provider quality in a rehabilitation service for disabled patients who receive the service frequently but do not have access to quality information. Previous research has found a positive relationship between patient choices and provider quality in health services that patients typically do not have previous experience or use frequently. We contribute by examining choices of new patients and experienced patients who were either forced to switch or actively switched their provider. In the analysis, we combine register data on patients’ choices and switches with provider quality data from a competitive bidding, and estimate conditional logit choice models. The results show that all patients prefer high-quality providers within short distances. We find that the willingness to travel for quality is highest among new patients and active switchers. These results suggest that new patients and active switchers compare different alternatives more thoroughly, whereas forced switchers choose their new provider in limited time leading into poorer choices.

NURS-09. INTRODUCTION OF A WELLNESS PROGRAM FOR PEDIATRIC NEURO-ONCOLOGY PROVIDERS

INTRODUCTION Pediatric oncology providers have unique and rewarding careers. The medical and psychosocial complexity of caring for pediatric oncology patients and their family units is simultaneously inspiring and challenging. In addition, the complex demands of the healthcare system can lead to chronic stress, burnout, and disruption to the healthcare professional’s individual well-being. Time constraints, lack of resources, and limited access to wellness interventions serve as barriers for providers to address adaptive coping within themselves. Identifying gaps to achieving wellness and implementing interventions may lead to improved equanimity for pediatric oncology providers in their personal lives as well as their medical practice. METHODS An interdisciplinary team of nurse practitioners and physicians in a large pediatric neuro-oncology program at an academic institution completed anonymized wellness self-assessments regarding the areas of emotional, environmental, intellectual, occupational, physical, social, spiritual, coping, and professional role wellness. The results were analyzed and barriers to provider health and well-being were identified. Tailored and regularly scheduled wellness interventions were implemented for the study participants addressing the identified wellness barriers. Participants will each complete post-intervention wellness self-assessments to evaluate the effectiveness of the program. CONCLUSION The introduction of a provider wellness program exemplifies a feasible approach to identify barriers and evaluate efficacy of wellness interventions in achieving multi-factorial provider wellness. Secondary aims include dissemination of findings, with the intention of cultivating improvement in provider quality of life throughout the healthcare profession, and the ultimate goal of improving care to patients and families.

Quality Advantage? Provider Quality and Networks in Medicare Advantage

Medicare Advantage plans have grown significantly over the past decade and the potential for their future growth seems unabated. Astonishingly, however, we know little about how Medicare beneficiaries access services, particularly whether those services are of high quality. This study explores access to cardiac surgeons for coronary artery bypass grafting (CABG) and heart valve surgery in California and New York. It is one of the first studies to analyze Medicare Advantage networks and interactions between provider networks and provider quality. Results of the study show that for large metropolitan areas, access is rather similar for traditional Medicare and Medicare Advantage beneficiaries. Limitations, however, exist for the latter. Important concerns emerge for Medicare Advantage beneficiaries outside of metropolitan areas where healthcare market challenges appear to be exacerbated by carrier restrictions. Results indicate no evidence that carriers selectively contract to improve quality. There is, however, significant diversity with regard to network breadth; and, this breadth does not stay static across distances. These results hold important implications for the future of the Medicare program, network adequacy regulations, and how consumers make choices about their insurance coverage.

Examining the Event Service Quality for Travelers with Mobility Impairments by Korean Caregivers' Perspective

Travelers with mobility impairments (TwMI) often have difficulty traveling alone due to various constraints and barriers. Caregivers of TwMI might play an important role in mitigating these constraints and barriers for TwMI. Knowing the event service quality for TwMI from the point of view of caregivers is essential for better quality of travel for both caregivers and TwMI. So far, although event service quality is important for people with disabilities, most of the studies have been conducted with people without disabilities. As caregivers' opinion is critical for deciding event participation, this study focused on perspective of caregivers regarding event service quality for TwMI. This study utilized structure equation modeling (SEM) analysis to empirically examine the relationship among event service quality for TwMI in terms of perspective of caregivers who accompanied TwMI to the event, caregivers' event satisfaction with TwMI, and caregivers' behavior intentions. From two event service qualities for TwMI, only service environment quality for TwMI demonstrated statistical significance on caregivers' event satisfaction with TwMI while service provider quality for TwMI had no statistical significance on both caregivers' event satisfaction with TwMI and caregivers' behavior intention. Caregivers' event satisfaction with TwMI demonstrated statistical significance on caregivers' behavior intention. Overall, this study may provide practical information to event organizers and other hospitality industries related to service quality for TwMI from various points of view.