Case-mix adjusting performance measures in a veteran population: pharmacy- and diagnosis-based approaches.
OBJECTIVE
To compare the rankings for health care utilization performance measures at the facility level in a Veterans Health Administration (VHA) health care delivery network using pharmacy- and diagnosis-based case-mix adjustment measures.


METHODS
The study included veterans who used inpatient or outpatient services in Veterans Integrated Service Network (VISN) 20 during fiscal year 1998 (October 1997 to September 1998; N = 126,076). Utilization and pharmacy data were extracted from VHA national databases and the VISN 20 data warehouse.


METHODS
We estimated concurrent regression models using pharmacy or diagnosis information in the base year (FY1998) to predict health service utilization in the same year. Utilization measures included bed days of care for inpatient care and provider visits for outpatient care.


RESULTS
Rankings of predicted utilization measures across facilities vary by case-mix adjustment measure. There is greater consistency within the diagnosis-based models than between the diagnosis- and pharmacy-based models. The eight facilities were ranked differently by the diagnosis- and pharmacy-based models.


CONCLUSIONS
Choice of case-mix adjustment measure affects rankings of facilities on performance measures, raising concerns about the validity of profiling practices. Differences in rankings may reflect differences in comparability of data capture across facilities between pharmacy and diagnosis data sources, and unstable estimates due to small numbers of patients in a facility.
VA Puget Sound Health Care System, Seattle, WA 98108, USA.
Chuan-Fen
CF
Liu
Anne E
AE
Sales
Nancy D
ND
Sharp
Paul
P
Fishman
Kevin L
KL
Sloan
Jeff
J
Todd-Stenberg
W Paul
WP
Nichol
Amy K
AK
Rosen
Susan
S
Loveland
D000368:Aged; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D005260:Female; D006302:Health Services Research; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D020379:Risk Adjustment / Q000379:methods*; D014728:Veterans / Q000706:statistics & numerical data*