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Adjusting Client-Level Risks Impacts on Home Care Organization Ranking.

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Summary

Risk adjustment is crucial for accurately comparing home care quality. This study developed a model for urinary incontinence (UI) quality indicators, showing that risk adjustment significantly impacts quality rankings of home care organizations (HCOs).

Keywords:
home carequality indicatorsquality of health carerisk adjustmenturinary incontinence

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Area of Science:

  • Gerontology
  • Health Services Research
  • Nursing Informatics

Background:

  • Quality indicators (QIs) using the Resident Assessment Instrument-Home Care (RAI-HC) enable home care organization (HCO) performance assessment.
  • Fair comparison of HCOs necessitates risk adjustment to account for patient case-mix differences.

Purpose of the Study:

  • Develop a risk adjustment model for worsening or new-onset urinary incontinence (UI) using RAI-HC data.
  • Evaluate the impact of risk adjustment on HCO quality rankings for UI care.

Main Methods:

  • Identified UI risk factors from scientific literature.
  • Developed a multivariable logistic regression model using the HomeCareData database.
  • Calculated observed and risk-adjusted QI rates, assessed uncertainty with bootstrapping, and analyzed tertile ranking shifts.

Main Results:

  • Included 12,652 clients from 76 Swiss HCOs (2017-2018).
  • Identified eight significant UI risk factors: older age, female sex, obesity, cognitive impairment, hygiene impairment, bathing impairment, unsteady gait, and hospitalization.
  • Risk adjustment considerably impacted HCO rankings, with 14 (20%) of 70 HCOs shifting tertiles.

Conclusions:

  • Risk adjustment is essential for equitable comparisons of UI care quality among HCOs.
  • The developed model demonstrated fair discrimination power for UI risk.
  • Findings underscore the importance of accounting for patient complexity in quality assessments.