All ETDs from UAB

Advisory Committee Chair

Robert Weech-Maldonado

Advisory Committee Members

Darrell Burke

Marianthe Grammas

Rita Jablonski

Tapan Mehta

Document Type


Date of Award


Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions


This three-paper dissertation sought to examine the existence of strategic groups in the home health industry, the application of Porter’s generic strategies (cost leader, differentiator, “stuck-in-the-middle” and both cost leader/differentiator) in identifying these groups, and the association of group membership with agency performance. The findings of this study will provide researchers and managers with a highlight of the current strategic makeup of the home health industry and its relationship with quality and financial performance. The results of this dissertation provide some evidence that strategic groups do exist in the home health industry and can be described along the basis of Porter’s generic strategies. Additionally, the results suggest that there is a relationship between group membership and quality and financial performance. Specifically, differentiators had better quality performance and higher operating revenue than cost leaders and stuck-in-the-middle agencies. Cost leaders had lower operating expenses than differentiators. In addition, both cost leader/differentiator agencies appeared to have the best overall performance. These agencies had a higher likelihood of being in the high tier of the quality star rating and were associated with higher percentages of patients who reported the most positive HHCAHPS reviews than all of the other groups. They also had higher operating revenue than the cost leader and lower operating expenses than the differentiators. The findings of these studies will help home health agency leaders in strategic decision making.



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