Adjusting Population Risk for Functional Health Status
Adjusting Population Risk for Functional Health Status
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DOI：
10.1089/pop.2015.0043
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发表时间：
2016-04-01
影响因子：
2.5
通讯作者：
Goldfield, Norbert I.
中科院分区：
文献类型：
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作者：
Fuller, Richard L.;Hughes, John S.;Goldfield, Norbert I.
风险调整通过降低管理式医疗计划选择登记者的可能性，并对提供者或计划绩效的其他偏倚报告进行纠正，来解释人口组合的差异。功能性健康状态通常不包括在风险调整方法中，但许多人认为，对于复杂的入组者和患者，功能性健康状态是风险调整的一个显著增强。在这项分析中，使用3种不同来源的功能评估工具创建了功能健康的标准化测量，这些工具以支付为条件提交给医疗保险计划。作者使用了2006年和2007年医疗保险索赔的5%发展样本，包括功能健康评估，并开发了一个功能健康分类模型，该模型包括由自我护理，移动性，失禁和认知障碍的相互作用定义的9组。这9个功能组被用来增强临床风险组，这是一个基于诊断的患者分类系统，当使用2010年和2011年100%的医疗保险数据的验证集时，这项研究发现使用功能健康模块可以提高观察到的注册者成本的拟合度，通过R-2统计量测量，在所有医疗保险注册者中提高5%。作者在构建模型时观察到功能健康领域之间复杂的非线性相互作用，并警告功能健康状态在用于风险调整时需要小心处理。如果处理得当，在现有的风险调整模型中增加功能性健康状况，有可能改善更复杂的登记者在护理费用融资方面的公平资源分配。（人口健康管理2016;19：136-144）
Risk adjustment accounts for differences in population mix by reducing the likelihood of enrollee selection by managed care plans and providing a correction to otherwise biased reporting of provider or plan performance. Functional health status is not routinely included within risk-adjustment methods, but is believed by many to be a significant enhancement to risk adjustment for complex enrollees and patients. In this analysis a standardized measure of functional health was created using 3 different source functional assessment instruments submitted to the Medicare program on condition of payment. The authors use a 5% development sample of Medicare claims from 2006 and 2007, including functional health assessments, and develop a model of functional health classification comprising 9 groups defined by the interaction of self-care, mobility, incontinence, and cognitive impairment. The 9 functional groups were used to augment Clinical Risk Groups, a diagnosis-based patient classification system, and when using a validation set of 100% of Medicare data for 2010 and 2011, this study found the use of the functional health module to improve the fit of observed enrollee cost, measured by the R-2 statistic, by 5% across all Medicare enrollees. The authors observed complex nonlinear interactions across functional health domains when constructing the model and caution that functional health status needs careful handling when used for risk adjustment. The addition of functional health status within existing risk-adjustment models has the potential to improve equitable resource allocation in the financing of care costs for more complex enrollees if handled appropriately. (Population Health Management 2016;19:136-144)