title: Risk adjustment for measuring health outcomes: an application in VA long-term care.
abstract: An empirically derived risk adjustment model is useful in distinguishing among facilities in their quality of care. We used Veterans Affairs (VA) administrative databases to develop and validate a risk adjustment model to predict decline in functional status, an important outcome measure in long-term care, among patients residing in VA long-term care facilities. This model was used to compare facilities on adjusted and unadjusted rates of decline. Predictors of decline included age, time between assessments, baseline functional status, terminal illness, pressure ulcers, pulmonary disease, cancer, arthritis, congestive heart failure, substance-related disorders, and various neurologic disorders. The model performed well in the development and validation databases (c statistics, 0.70 and 0.68, respectively). Risk-adjusted rates and rankings of facilities differed from unadjusted ratings. We conclude that judgments of facility performance depend on whether risk-adjusted or unadjusted decline rates are used. Valid risk adjustment models are therefore necessary when comparing facilities on outcomes.
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, Bedford VAMC (152), 200 Springs Rd, Bedford, Mass. 01730, USA. akrosen@bu.edu
authors.forename: A
authors.initials: A
authors.lastname: Rosen
authors.forename: J
authors.initials: J
authors.lastname: Wu
authors.forename: B H
authors.initials: BH
authors.lastname: Chang
authors.forename: D
authors.initials: D
authors.lastname: Berlowitz
authors.forename: C
authors.initials: C
authors.lastname: Rakovski
authors.forename: A
authors.initials: A
authors.lastname: Ash
authors.forename: M
authors.initials: M
authors.lastname: Moskowitz
mesh_terms: D000368:Aged; D003953:Diagnosis-Related Groups; D005069:Evaluation Studies as Topic; D016330:Frail Elderly; D006801:Humans; D007348:Insurance, Health; D008134:Long-Term Care / Q000592:standards; D017146:Models, Organizational; D009735:Nursing Homes / Q000592:standards*; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D020379:Risk Adjustment / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs