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

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.

项目概要 而患者的社会经济地位（SES）作为健康社会决定因素（SDH）的关键要素 显着影响临床护理质量和结果，通常超出医疗保健的控制范围 组织 (HCO)、HCO 和信徒对护理质量和结果负责。 因此，当不考虑患者的 SES 时，可能会出现意想不到的负面后果 对 HCO 来说处于不利地位，特别是那些为弱势群体服务的 HCO，因为它们对 联邦和州绩效工资计划下的问责申请（例如付款）。 针对这些担忧，国家质量论坛（NQF）和国家质检总局发布了 2017 年报告。 医学会 (NAM) 建议根据患者的 SES 调整 HCO 的性能。 NAM 和 NQF 都建议，有关社会风险因素的数据应尽可能细化，以 为了确保准确性，他们强调缺乏针对个人层面 SES 的合适衡量标准是关键 对 HCO 绩效进行准确风险调整的挑战，例如一些个人层面的 SES 措施。 医疗补助资格是可用的，但由于重大风险，它们仍然不适合准确的风险调整 群体内的异质性和社会经济地位缺乏粒度 此外，总体层面的社会经济地位衡量标准也是如此。 常规使用，但未能捕捉到一些优质护理措施与 SES 的关联。 明尼苏达州立法机构授权该州开发并报告合适的风险调整模型 为解决健康差异问题，2017 年明尼苏达州卫生部质量报告系统风险 调整评估报告还认识到缺乏个人层面的 SES 措施是一个重要的因素。 有效和公平的风险调整的障碍以及可用的总体层面 SES 措施的局限性。 HOUSES（基于 HOUsing 的 SES）指数是经过验证的个人层面 SES 指数，克服了这一不足 个人层面的 SES 措施，同时解决传统 SES 措施的局限性。 针对改进风险调整方法的挑战，我们建议1）实施HOUSES 目前仅在整个明尼苏达州的明尼苏达州东南部县提供（目标 1）； 确定 2017 年明尼苏达社区评估 (MNCM) 中可用的绩效指标 报告对 HOUSES 衡量的 SES 敏感（目标 2a），并且 3）制定改进的风险调整； 模型将患者的 HOUSES 纳入 HCO 的绩效指标（目标 2b）。 为了解决这个问题，这项研究将是在美国范围内扩大房屋规模的不可或缺的一步。 缺乏适当的个人层面的 SES 措施是国家层面适当风险的主要挑战 调整并缓解利益相关者（例如患者、鸡群、HCO、付款人和 它将帮助利益相关者实现1）更有效和公平的风险调整和支付。 绩效，2) 对 HCO 的高价值护理，以及 3) 社区伙伴关系。