Does risk adjustment of the CMS quality measures for nursing homes matter?
Does risk adjustment of the CMS quality measures for nursing homes matter?
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DOI：
10.1097/mlr.0b013e31816099c5
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发表时间：
2008-05-01
期刊：
影响因子：
3
通讯作者：
Mosqueda, Laura
中科院分区：
文献类型：
--
作者：
Mukamel, Dana B.;Glance, Laurent G.;Mosqueda, Laura
背景：医疗保险和医疗补助服务中心（CMS）发布了一份包含19项临床质量指标（QM）的养老院报告卡。这些措施包括最小的风险adjustment.Objectives：开发更广泛的风险调整QM和调查的影响quality rankings.Research Design：回顾性分析的最小数据集（MDS）中报告的个人水平的数据。随机效应逻辑模型用于估计5种结局的风险调整模型：高风险和低风险患者的压疮、身体限制以及长期和短期住院患者的疼痛。这些模型用于创建5个具有扩展风险调整、增强QM（EQM）的QM。EQMs与相应的QMS.Subjects：所有（17,469）养老院报告MDS数据在2001-2005年期间，和他们的960万居民比较：QMs与EQMs的所有养老院在协议离群值识别：Kappa，假阳性和假阴性错误率。假阳性和阴性错误率范围为8%至37%。QMs和EQMs之间的协议是更好的高质量，而不是低quality.Conclusions：更广泛的风险调整改变质量排名的养老院，应被视为潜在的改善目前的QMs。其他有关建设的质量管理体系的方法问题也应该调查，以确定他们是否是重要的背景下，养老院护理。
Background: The Centers for Medicare and Medicaid Services (CMS) publish a report card for nursing homes with 19 clinical quality measures (QMs). These measures include minimal risk adjustment.Objectives: To develop QMs with more extensive risk adjustment and to investigate the impact on quality rankings.Research Design: Retrospective analysis of individual level data reported in the Minimum Data Set (MDS). Random effect logistic models were used to estimate risk adjustment models for 5 outcomes: pressure ulcers for high and low risk patients, physical restraints, and pain for long- and short-stay patients. These models were used to create 5 QMs with extended risk adjustment, enhanced QMs (EQMs). The EQMs were compared with the corresponding QMs.Subjects: All (17,469) nursing homes that reported MDS data in the period 2001-2005, and their 9.6 million residents.Measures: QMs were compared with EQMs for all nursing homes in terms of agreement on outlier identification: Kappa, false positive and false negative error rates.Results: Kappa values ranged from 0.63 to 0.90. False positive and negative error rates ranged from 8% to 37%. Agreement between QMs and EQMs was better on high quality rather than on low quality.Conclusions: More extensive risk adjustment changes quality ranking of nursing homes and should be considered as potential improvement to the current QMs. Other methodological issues related to construction of the QMs should also be investigated to determine if they are important in the context of nursing home care.