Adjusting for Social Risk Factors in Pediatric Quality Measures: Adding to the Evidence Base.
Adjusting for Social Risk Factors in Pediatric Quality Measures: Adding to the Evidence Base.
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DOI：
10.1016/j.acap.2021.09.023
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发表时间：
2022-04
影响因子：
3.1
通讯作者：
Bardach, Naomi
中科院分区：
文献类型：
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作者：
Bucholz, Emily M;Toomey, Sara L;McCulloch, Charles E;Bardach, Naomi
结果和利用质量的措施，调整病人的情况组合，包括人口统计学特征和共病条件，允许医院和健康计划之间的比较。然而，关于是否以及如何调整社会风险因素存在争议。评估将社会风险变量纳入儿科质量测量计划（PQMP）的儿科利用率测量的方法。我们使用来自CA Medicaid索赔（2015-16）和马萨诸塞州所有付款人索赔数据库（2014-2015）的数据，使用儿科哮喘急诊室使用指标的指标规范计算健康计划绩效。使用混合效应负二项模型评估健康计划绩效类别，调整和不调整社会风险因素，两种模型均调整年龄，性别和慢性疾病类别。然后使用混合效应线性模型来比较改变性能类别的健康计划的患者社会风险与没有改变性能类别的健康计划的患者社会风险。在为404，649名哮喘儿童患者提供服务的133个健康计划中，7-13%在社会风险调整后改变了绩效类别。健康计划转移到更高的性能类别照顾较低的SES患者，而那些转移到较低的性能类别照顾较高的SES患者。社会风险因素的调整改变了大量健康计划的PQMP儿科哮喘急诊使用指标的绩效排名，一些健康计划照顾风险较高的患者，但没有进行社会风险因素风险调整。有鉴于此，社会风险因素被纳入国家质量论坛认可的措施;是否将社会风险因素纳入儿科质量措施将取决于用例。
Outcome and utilization quality measures are adjusted for patient case-mix including demographic characteristics and comorbid conditions to allow for comparisons between hospitals and health plans. However, controversy exists around whether and how to adjust for social risk factors. To assess an approach to incorporating social risk variables into a pediatric measure of utilization from the Pediatric Quality Measures Program (PQMP). We used data from CA Medicaid claims (2015–16) and Massachusetts All Payer Claims Database (2014–2015) to calculate health plan performance using measure specifications from the Pediatric Asthma Emergency Department Use measure. Health plan performance categories were assessed using mixed effect negative binomial models with and without adjustment for social risk factors, with both models adjusting for age, gender and chronic condition category. Mixed effects linear models were then used to compare patient social risk for health plans that changed performance categories to patient social risk for health plans that did not. Of 133 health plans, serving 404,649 pediatric patients with asthma, 7–13% changed performance categories after social risk adjustment. Health plans that moved to higher performance categories cared for lower SES patients whereas those that moved to lower performance categories cared for higher SES patients. Adjustment for social risk factors changed performance rankings on the PQMP Pediatric Asthma Emergency Department Use measure for a substantial number of health plans, with some health plans caring for higher risk patients with lower performance without social risk factor risk adjustment. In light of this, social risk factors are incorporated into the National Quality Forum-endorsed measure; whether to incorporate social risk factors into pediatric quality measures will differ depending on the use case.