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.

项目摘要 虽然患者的社会经济地位（SES）作为健康社会决定因素（SDH）的关键因素， 显著影响临床护理质量和结果，它往往超出了卫生保健的控制范围 卫生组织（HCO）和HCO和临床医生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。 对人道主义事务协调员，特别是那些为弱势群体服务的人道主义事务协调员不利， 根据联邦和州绩效工资计划的问责制应用程序（如付款）。 针对这些问题，2017年国家质量论坛（NQF）和国家 美国医学院（NAM）建议根据患者的SES调整HCO的性能。重要的是， 而NAM和NQF都建议有关社会风险因素的数据应尽可能细化， 为了确保准确性，他们强调缺乏一个合适的衡量个人层面的SES的关键， 对人道主义事务协调员业绩进行准确风险调整的挑战。一些个人层面的社会经济地位指标，如 医疗补助资格是可用的，但他们仍然不适合准确的风险调整，由于显着 组内异质性和缺乏粒度为一个人的SES。此外，总体一级的社会经济地位措施是 常规使用，但未能捕获一些质量护理措施与SES的关联。而 明尼苏达州立法机构授权该州制定并报告一个合适的风险调整模型 解决健康差距，2017年明尼苏达州卫生部的质量报告系统风险 《调整评估报告》还承认，缺乏个人层面的社会经济地位衡量标准是一个重要的影响因素， 有效和公平的风险调整的障碍，以及可用的总体水平SES措施的局限性。 HOUSES（基于住房的社会经济地位）指数是一个经过验证的个人层面的社会经济地位指数，它克服了这种缺乏 个人层面的SES措施，同时解决传统的SES措施的局限性。 为了应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东南部MN县提供（目标1）; 2） 确定2017年明尼苏达州社区测量（MNCM）中可用的绩效指标 报告对房屋测量的SES敏感（目标2a）;以及3）开发改进的风险调整 将患者之家纳入HCO绩效指标的模型（目标2b）。拟议 这项研究将是在美国各地扩大住房的一个不可或缺的步骤，目的是解决 缺乏适当的个人社会经济地位措施，这是国家一级适当风险的一个关键挑战 调整和缓解利益相关者（例如，患者、临床医生、HCO、付款人和 政府）。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）HCO的高价值护理，以及3）社区伙伴关系。