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- Title
Associations Between Certificate of Need Policies and Hospice Quality Outcomes.
- Authors
Gaines, Arlen G.; Cagle, John G.
- Abstract
Background: Certificate of need (CON) laws are state-based regulations requiring approval of new healthcare entities and capital expenditures. Varying by state, these regulations impact hospices in 14 states and DC, with several states re-examining provisions. Aim: This cross-sectional study examined the association of CON status on hospice quality outcomes using the hospice item set metric (HIS). Design: Data from the February 2022 Medicare Hospice Provider and General Information reports of 4870 US hospices were used to compare group means of the 8 HIS measures across CON status. Multiple regression analysis was used to predict HIS outcomes by CON status while controlling for ownership and size. Results: Approximately 86% of hospices are in states without a hospice CON provision. The unadjusted mean HIS scores for all measures were higher in CON states (M range 94.40-99.59) than Non-CON (M range 90.50-99.53) with significant differences in all except treatment preferences. In the adjusted model, linear regression analyses showed hospice CON states had significantly higher HIS ratings than those from Non-CON states for beliefs and values addressed (β =.05, P =.009), pain assessment (β =.05, P =.009), dyspnea treatment (β =.08, P <.001) and the composite measure (β =.09, P <.001). Treatment preferences, pain screening, dyspnea screening, and opioid bowel treatment were not statistically significant (P >.05). Conclusion: The study suggests that CON regulations may have a modest, but beneficial impact on hospice-reported quality outcomes, particularly for small and medium-sized hospices. Further research is needed to explore other factors that contribute to HIS outcomes.
- Subjects
UNITED States; PAIN diagnosis; DIAGNOSIS of dyspnea; TREATMENT of dyspnea; CLINICAL medicine; CROSS-sectional method; PAIN measurement; MEDICAL quality control; CENTERS for Medicare &; Medicaid Services (U.S.); T-test (Statistics); DATA analysis; STATISTICAL hypothesis testing; KEY performance indicators (Management); MULTIPLE regression analysis; CHI-squared test; DESCRIPTIVE statistics; OPIOID analgesics; STATISTICS; HEALTH outcome assessment; REPORT writing; CONFIDENCE intervals; DATA analysis software; HOSPICE care; GOVERNMENT regulation; REGRESSION analysis; PATIENTS' attitudes; SENSITIVITY &; specificity (Statistics)
- Publication
American Journal of Hospice & Palliative Medicine, 2024, Vol 41, Issue 5, p471
- ISSN
1049-9091
- Publication type
Article
- DOI
10.1177/10499091231180613