The National Institute on Aging awarded the University of California, Irvine, (UCI) Department of Medicine, a 4 year grant (Award # R01 AG051719) to study the relationship between costs and quality in home health, where quality is measured primarily as the health outcomes and the quality measures (QMs) reported in Home Health Compare.

Understanding the relationships between costs, improvement in quality and QMs and the strategies that lead to improvement in QMs are important as HHAs position themselves in an era of value based payment. The information that this study sought to provide was intended to inform both policy makers and HHAs.


To this end we collected two data types:

  • We surveyed HHAs in early 2018 about the quality improvement actions they engaged in during the prior 5 years. We received responses from 1,192 HHAs nationally. We obtained data about annual expenditures, QMs and other agency characteristics for 7,673 HHAs nationally for the period 2014-2017. Data were obtained from CMS and other public data sources, including the Medicare cost reports, OASIS data, Home Health Compare data. All data sources were combined into an analytical data set, with data merged at the HHA level.
  • Statistical regression techniques were used to analyze these data and identify the relationship between:
    • The implementation of specific quality improvement actions and improvement in specific QMs
    • The implementation of specific quality improvement actions and the TOTAL (net) cost of the action (including implementation costs and any potential savings due to improvement).