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Risk Adjustment for Measuring Health Outcomes: An Application in VA Long term Care

Center for Health Quality, Outcomes, and Economic Research (CHQOER), Bedford VAMC, Bedford, Mass, Boston University School of Public Health, Boston, Mass, akrosen{at}bu.edu

Jeanne Wu, MS

RxRemedy, Inc, Westport, Conn

Bei-Hung Chang, ScD

CHQOER, Boston University School of Public Health

Dan Berlowitz, MD, MPH

CHQOER

Carter Rakovski, MS

CHQOER

Arlene Ash, PhD

Evans Memorial Department of Medicine, Boston Medical Center, Boston, Mass

Mark Moskowitz, MD

Boston Medical Center, Boston, Mass

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.

Key Words: Case-mix • long-term care • profiling • quality assessment • risk-adjusted outcomes

American Journal of Medical Quality, Vol. 16, No. 4, 118-127 (2001)
DOI: 10.1177/106286060101600403


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