Risk Adjustment of Outcome Measures

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
November 21st, 2014

The outcome of care measures and the utilization measures are risk adjusted. The process of care measures aren't risk adjusted. Risk adjustment of the outcome of care and utilization measures is a multi-step process. These are the major steps in this process displayed in temporal order:

The purpose of risk adjusting outcome and utilization measures is to adjust reported values to account for case-mix differences among home health agencies. That is, by adjusting the observed improvement rates for home health agencies with different patient clientele (case-mix differences), the resulting displayed value more closely reflects differences in agency quality.

Prediction model development — improvement and utilization outcomes

For OASIS-based quality measures, prediction models use patient case mix information taken from OASIS-C SOC/ROC assessments to establish a relationship between these characteristics and the likelihood of a quality outcome. Each improvement and utilization outcome has its own unique prediction model. Virtually every item on OASIS-C, with the exception of a few demographic/patient tracking items and clinical record items, are potential risk factors that can be used to create this prediction equation.

For claims-based utilization quality measures, prediction models use patient case mix information taken from previous Medicare claims data across all care settings to establish the relationship between these characteristics and the likelihood of a quality outcome. Many diagnoses items from previous Medicare claims are potential risk factors.

Several changes in the prediction model building process account for the quality of these prediction models, including:

The statistical and analytic methodology used to create the prediction models includes these steps:

References:

Risk Adjustment of Outcome Measures. (2014, November 21). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/risk-adjustment-of-outcome-measures-2384.html

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