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Risk adjustment of nursing home quality indicators
G Arling1, S L Karon, F Sainfort
1Bloch School of Business and Public Administration, University of Missouri-Kansas City 64110, USA. garling@cctr.umkc.edu
The Gerontologist
|January 20, 1998
Summary
This study developed a risk adjustment method for nursing home quality indicators (QI). Risk adjustment reveals significant differences in care quality between facilities that may otherwise be hidden.
Area of Science:
- Gerontology
- Health Services Research
- Quality Improvement
Background:
- Nursing home quality indicators (QI) assess care processes and resident outcomes.
- Effective QI use requires accounting for patient risk factors.
- Existing methods may not adequately adjust for resident-level risk.
Purpose of the Study:
- To develop and evaluate a novel risk adjustment methodology for nursing home QI.
- To improve the accuracy of quality comparisons across nursing homes.
- To identify care quality variations independent of resident risk.
Main Methods:
- Developed a risk adjustment approach by stratifying residents into high and low-risk groups.
- Calculated QI rates within these risk strata.
- Compared QI rates across nursing homes using the developed method.
- Analyzed data from over 800 nursing homes across four states.
Main Results:
- Substantial differences in QI rates were observed between facilities, even after risk adjustment.
- The risk adjustment method highlighted variations in care quality not apparent without controlling for risk.
- The methodology proved effective in differentiating facility performance based on adjusted QI rates.
Conclusions:
- The developed risk adjustment method enhances the validity of nursing home quality indicator comparisons.
- Risk adjustment is crucial for accurately assessing and comparing nursing home care quality.
- This approach provides a more equitable framework for evaluating facility performance and identifying areas for improvement.