Case-Mix Adjustment of Consumer Reports about Managed Behavioral Health Care and Health Plans
Case-Mix Adjustment of Consumer Reports about Managed Behavioral Health Care and Health Plans
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DOI：
10.1111/j.1475-6773.2008.00894.x
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发表时间：
2008-12-01
影响因子：
3.4
通讯作者：
Busch, Susan H.
中科院分区：
文献类型：
--
作者：
Eselius, Laura L.;Cleary, Paul D.;Busch, Susan H.
建立一个模型，用于调整患者对护理体验和健康结局的行为健康护理体验报告（ECHO（TM））调查，以便对各种健康计划进行公平比较。068人参加了21个管理行为健康计划，他们在过去一年内接受了行为健康护理潜在的病例组合调节剂通过结合其预测能力和计划内和计划间变异性的信息进行评估。由于病例组合调整，计划得分和排名的变化进行了量化。最终的病例组合调整模型包括自我报告的心理健康状况，自我报告的一般健康状况，酒精/药物治疗，年龄，教育和种族/民族。调整对计划报告评分的影响是适度的，但足以改变一些计划ranking.Adjusting计划报告评分的ECHO调查的患者特征的差异有适度的影响，但仍然可能是重要的，以保持病人的报告作为质量指标的可信度。与那些在优秀/非常好的健康相比，那些自我报告的公平/差的健康之间的差异因计划而异，这表明与健康状况相关的质量差异，并强调收集质量信息的重要性。
To develop a model for adjusting patients' reports of behavioral health care experiences on the Experience of Care and Health Outcomes (ECHO (TM)) survey to allow for fair comparisons across health plans.Survey responses from 4,068 individuals enrolled in 21 managed behavioral health plans who received behavioral health care within the previous year (response rate=48 percent).Potential case-mix adjustors were evaluated by combining information about their predictive power and the amount of within- and between-plan variability. Changes in plan scores and rankings due to case-mix adjustment were quantified.The final case-mix adjustment model included self-reported mental health status, self-reported general health status, alcohol/drug treatment, age, education, and race/ethnicity. The impact of adjustment on plan report scores was modest, but large enough to change some plan rankings.Adjusting plan report scores on the ECHO survey for differences in patient characteristics had modest effects, but still may be important to maintain the credibility of patient reports as a quality metric. Differences between those with self-reported fair/poor health compared with those in excellent/very good health varied by plan, suggesting quality differences associated with health status and underscoring the importance of collecting quality information.