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Risk Adjustment Methods Can Affect Perceptions of Outcomes

Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Hospital, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory

Michael Shwartz, Ph.D.

Health Care Management Program and Operations, Management Department, School of Management, Boston University

Arlene S. Ash, Ph.D.

Health Care Research UnitSection of General Internal Medicine, Evans Memorial Department of Clinical Research and Medicine, Boston University Medical Center, Boston, Massachusetts

Yevgenia Mackiernan, B.A.

Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Hospital, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory

Elizabeth K. Hotchkin, B.A.

Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Hospital, the Charles A. Dana Research Institute, and the Harvard-Thorndike Laboratory

When comparing outcomes of medical care, it is essential to adjust for patient risk, including severity of illness. A variety of severity measures exist, but perceptions of outcomes may differ depending on how severity is defined. We used two severity-adjustment approaches to demonstrate that comparisons of out comes across subgroups of patients can vary dramat ically depending on how severity is assessed. We stud ied two approaches: model 1 was the admission MedisGroups score; model 2 was computed from age and 12 chronic conditions defined by diagnosis codes. Although common summary measures of model per formance (R-squared and C) both suggested that model 1 is a better predictor of in-hospital death than model 2, the weaker model consistently produced more accurate expectations by payer class and age group. Using model 1 for severity adjustment sug gested that Medicare patients did substantially worse than expected and Medicaid patients substantially better. In contrast, use of model 2 found Medicare patients doing as expected, but Medicaid patients far ing poorly.

American Journal of Medical Quality, Vol. 9, No. 2, 43-48 (1994)
DOI: 10.1177/0885713X9400900202


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