Case mix adjustment in nursing systems research: the case of resident outcomes in nursing homes.
Case mix indicates, for a resident population, the degree of risk for developing favorable or unfavorable outcomes. In a study of 164 nursing homes, we explored two methods for combining resident assessment data into a case mix index (CMI). We compared a facility-level, composite CMI to a prevalence-based CMI comprised of 22 separate resident characteristics for their adequacy in explaining resident outcomes. The prevalence-based CMI consistently explained more variance in outcomes than the facility level, composite CMI. This study indicates a reasonable method for using administrative databases containing resident assessment data to adjust for the influence of case mix on nursing home resident outcomes.
Anderson
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Duke University School of Nursing, DUMC 3322, Durham, NC 27710, USA.
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Hsieh
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Allred
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Owensby
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Joiner-Rogers
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D050723:Fractures, Bone; D006801:Humans; D001523:Mental Disorders; D015401:Nursing Administration Research / Q000379:methods*; D009732:Nursing Care / Q000592:standards*; D009735:Nursing Homes / Q000592:standards* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000458:organization & administration; D019984:Quality Indicators, Health Care; D020379:Risk Adjustment / Q000458:organization & administration; D012307:Risk Factors; D013781:Texas