−10 Deviancy on all colonies if Gestalt Consciousness.Unlocks the Enhanced Surveillance edict if not Gestalt Consciousness.+1 Unity per Enforcer if not Gestalt Consciousness.−25% Empire Size from districts if Machine Intelligence.
The adoption and finisher effects both count as traditions in their own right, so starting a group counts as one tradition, and unlocking the last tradition in a group counts as two. "Empire size effect" is a modifier to the effect of empire size on its associated penalties, including tradition cost it is affected by certain authorities. "Tech/tradition cost" refers to the game setting. The tradition cost formula is the following: The Milbank Quarterly published by Wiley Periodicals LLC on behalf of The Milbank Memorial Fund.The cost of unlocking a tradition depends on how many traditions the empire has already unlocked, as well as the empire size cost. Targeted interventions should focus on raising awareness around the five-star ratings.Īccess home health public reporting quality racial inequities. Policymakers should be aware of the potential unintended consequences for implementing home health public reporting, specifically for Hispanic/Latine, Asian American/Pacific Islander, and low-income home health patients, as well as patients residing in predominantly Hispanic/Latine neighborhoods. Other neighborhoods experience a nonsignificant change in high-quality home health agency use. We also observed that patients within predominantly Hispanic/Latine neighborhoods had a significant decrease in their use of high-quality home health agencies, whereas patients in predominantly White and integrated neighborhoods had a significant increase in high-quality home health agency use. Additionally, we found that the disparity in high-quality home health agency use between low-income and higher-income home health patients was exacerbated after the introduction of the five-star quality ratings. To estimate the impact of the home health five-star rating introduction on the use of high-quality home health agencies, we use a longitudinal observational pretest-posttest design.Īfter the introduction of the home health five-star ratings in 2016, we found that adjusted rates of high-quality home health agency use increased for all home health patients, except for Hispanic/Latine and Asian American/Pacific Islander patients. We use data from the Outcome and Assessment Information Set, Medicare Enrollment Files, Care Compare, and American Community Survey to estimate differential access to high-quality home health agencies between July 2014 and June 2017. The objective of this study is to evaluate the impact of the home health five-star ratings on changes in high-quality home health agency use by race, ethnicity, income status, and place-based factors. Literature suggests that public reporting of quality may have the unintended consequence of exacerbating disparities in access to high-quality, long-term care for older adults. Targeted federal, state, and local interventions should focus on raising awareness about the five-star quality ratings among marginalized populations for whom inequities have been exacerbated. Ensuring equitable access to home health requires taking a closer look at potentially inequitable policies to ensure that these policies are not inadvertently exacerbating disparities as home health public reporting potentially does. Policy Points Public reporting is associated with both mitigating and exacerbating inequities in high-quality home health agency use for marginalized groups.
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