Improving the Risk Adjustment Method for Quality Care Measures through Application of an Innovative Individual-Level Socioeconomic Measure

通过应用创新的个人层面的社会经济措施，改进优质护理措施的风险调整方法

• 批准号: 10394328
• 负责人: YOUNG J JUHN
• 金额: $ 19.88万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10394328
• 关键词: Academy; Accountability; Accounting; Accreditation; Address; Adult; Behavior; Caring; Child; Communities; County; Data; Data Collection; Data Set; Disadvantaged; Ecological Bias; Elements; Ensure; Family; Geographic Locations; Goals; Government; Health; Health Services Accessibility; Healthcare; Heterogeneity; Home visitation; Housing; Income; Individual; Joints; Link; Logistics; Masks; Measurement; Measures; Medicaid eligibility; Medicare; Medicine; Methodology; Methods; Minnesota; Modeling; Outcome; Outcome Measure; Patient Self-Report; Patients; Performance; Policies; Population; Population Analysis; Positioning Attribute; Process; Property; Quality of Care; Reporting; Resources; Risk; Risk Adjustment; Risk Factors; Sampling Studies; Sioux Falls; Site; Socioeconomic Status; Subgroup; Surrogate Markers; System; Taxes; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Validation; Vendor; Vulnerable Populations; acute care; base; beneficiary; clinical care; community partnership; cost; disadvantaged population; disparity reduction; experience; health care service organization; health disparity; health equity; high risk; hospital readmission; improved; indexing; innovation; patient population; payment; programs; response; social; social health determinants; socioeconomics; Academy; Accountability; Accounting; Accreditation; Address; Adult; Behavior; Caring; Child; Communities; County; Data; Data Collection; Data Set; Disadvantaged; Ecological Bias; Elements; Ensure; Family; Geographic Locations; Goals; Government; Health; Health Services Accessibility; Healthcare; Heterogeneity; Home visitation; Housing; Income; Individual; Joints; Link; Logistics; Masks; Measurement; Measures; Medicaid eligibility; Medicare; Medicine; Methodology; Methods; Minnesota; Modeling; Outcome; Outcome Measure; Patient Self-Report; Patients; Performance; Policies; Population; Population Analysis; Positioning Attribute; Process; Property; Quality of Care; Reporting; Resources; Risk; Risk Adjustment; Risk Factors; Sampling Studies; Sioux Falls; Site; Socioeconomic Status; Subgroup; Surrogate Markers; System; Taxes; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Validation; Vendor; Vulnerable Populations; acute care; base; beneficiary; clinical care; community partnership; cost; disadvantaged population; disparity reduction; experience; health care service organization; health disparity; health equity; high risk; hospital readmission; improved; indexing; innovation; patient population; payment; programs; response; social; social health determinants; socioeconomics

PROJECT SUMMARY While patients’ socioeconomic status (SES) as a key element of social determinants of health (SDH) significantly impacts clinical care quality and outcomes, it is often beyond the control of health care organizations (HCOs), and HCOs and clinicians have been held accountable for care quality and outcomes. Thus, when SES of patients is not accounted for, there are unintended negative consequences that can be detrimental to the HCOs, especially those serving disadvantaged populations, due to their implications on accountability applications (eg, payment) under the federal and state pay-for-performance programs. In response to these concerns, the 2017 reports from the National Quality Forum (NQF) and the National Academy of Medicine (NAM) recommend adjusting performance of HCOs for patients’ SES. Importantly, while both NAM and NQF suggested that data on social risk factors should be as granular as possible to ensure accuracy, they highlighted the lack of a suitable measure for individual-level SES as the key challenge for accurate risk-adjustment of HCOs’ performance. Some individual-level SES measures such as Medicaid eligibility are available, but they are still unsuitable for accurate risk adjustment due to significant within-group heterogeneity and lack of granularity for one’s SES. Also, aggregate-level SES measures are routinely used but have failed to capture some quality care measures’ associations with SES. While the Minnesota State legislature mandated the state to develop and report a suitable risk adjustment model addressing health disparities, the 2017 Minnesota Department of Health’s Quality Reporting System Risk Adjustment Assessment Report also recognizes the lack of individual-level SES measures as an important barrier to effective and fair risk adjustment and the limitations of available aggregate-level SES measures. The HOUSES (HOUsing-based SES) index, a validated individual-level SES index, overcomes this dearth of individual-level SES measures while addressing the limitations of conventional SES measures. Addressing the challenges to improving the risk adjustment method, we propose 1) to implement HOUSES that is currently only available in Southeast MN counties throughout the entire state of Minnesota (Aim 1); 2) to determine which performance metrics available in the 2017 Minnesota Community Measurement (MNCM) report are sensitive to SES as measured by HOUSES (Aim 2a); and 3) develop an improved risk adjustment model incorporating the HOUSES of patients on the performance metrics of HCOs (Aim 2b). The proposed study will be an indispensable step in expanding HOUSES across the US for the purpose of addressing the lack of suitable individual-level SES measures as a key challenge at a national level for proper risk adjustment and easing the unmet needs of stakeholders (eg, patients, clinicians, HCOs, payers, and government). It will help the stakeholders to achieve 1) more valid and equitable risk adjustment and pay for performance, 2) high-value care for HCOs, and 3) community partnership.

项目摘要 而患者的社会经济地位（SES）是卫生社会决定者（SDH）的关键要素 显着影响临床护理质量和结果，通常无法控制医疗保健 组织（HCO）以及HCO和临床医生对护理质量和成果负责。 当不考虑患者的SES时，会有意想不到的负面后果 不利于HCO，尤其是那些服务不利人群的人，因为它们对 责任申请（例如，付款），根据联邦和州的绩效计划。 为了应对这些问题，国家质量论坛（NQF）和国家的2017年报告 医学院（NAM）建议调整患者SES的HCO的性能。重要的是， 虽然NAM和NQF都建议有关社会风险因素的数据应尽可能颗粒 确保准确性，他们强调了缺乏适合个人级别SE作为钥匙的措施 挑战HCO的准确风险调整。一些个人级别的SES措施，例如 可以使用医疗补助资格，但由于重要的 组内异质性和缺乏粒度的SES。此外，总级别的SES度量是 通常使用但未能捕获一些优质的护理措施与SES的关联。而 明尼苏达州立法机关要求该州开发和报告合适的风险调整模型 解决健康分配，2017年明尼苏达州卫生局质量报告系统风险 调整评估报告还认识到缺乏个人水平的措施是重要的 有效和公平风险调整的障碍以及可用骨料级别测量值的局限性。 房屋（基于住房的SES）索引，经过验证的个人级SES索引，克服了这一死亡 在解决常规SES测量的局限性的同时，个人级别的测量值。 解决改善风险调整方法的挑战，我们建议1）实施房屋 目前仅在明尼苏达州东南部县可用（AIM 1）； 2） 确定2017年明尼苏达州社区测量（MNCM）中可用的绩效指标 报告对由房屋测量的SE敏感（AIM 2A）； 3）改善了风险调整 模型将患者的房屋纳入HCO的性能指标（AIM 2B）。提议 研究将是在美国扩大房屋的必不可少的一步，目的是解决 缺乏适当的个人SES措施作为国家一级的关键挑战 调整和减轻利益相关者未满足的需求（例如，患者，临床医生，HCO，付款人和 政府）。它将帮助利益相关者实现1）更有效，更公平的风险调整并支付 绩效，2）针对HCO的高价值护理和3）社区伙伴关系。