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Risk adjustment for measuring health outcomes: an application in VA long-term care
1Center for Health Quality, Outcomes and Economic Research, Bedford VAMC (152), 200 Springs Rd, Bedford, Mass. 01730, USA. akrosen@bu.edu
Summary
Developing a risk adjustment model for Veterans Affairs (VA) long-term care facilities is crucial. This model accurately predicts functional decline, enabling fair quality of care comparisons between facilities.
Area of Science:
- Health Services Research
- Gerontology
- Quality Improvement
Background:
- Assessing quality of care in long-term care facilities is challenging.
- Risk adjustment is essential for fair comparisons of healthcare outcomes.
- Functional status decline is a key outcome measure in long-term care.
Purpose of the Study:
- To develop and validate a risk adjustment model using Veterans Affairs (VA) administrative data.
- To predict decline in functional status among patients in VA long-term care facilities.
- To compare VA facilities based on risk-adjusted and unadjusted rates of functional decline.
Main Methods:
- Utilized VA administrative databases for model development and validation.
- Identified predictors of functional decline including demographics, comorbidities, and specific conditions.
- Employed statistical methods to assess model performance (c-statistics).
Main Results:
- The risk adjustment model demonstrated good performance in both development (c=0.70) and validation (c=0.68) datasets.
- Key predictors of decline included age, baseline functional status, and various medical conditions.
- Risk-adjusted facility rankings differed significantly from unadjusted rankings.
Conclusions:
- Judgments of facility performance in long-term care are dependent on the use of risk-adjusted versus unadjusted outcome rates.
- Empirically derived risk adjustment models are necessary for accurate comparisons of facility quality.
- This validated model can aid in distinguishing facility quality based on patient outcomes.
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