Improving the Risk Adjustment Method for Quality Care Measures through Application of an Innovative Individual-Level Socioeconomic Measure

项目总结 而患者的社会经济地位(SES)作为健康的社会决定因素(SDH)的关键因素 显著影响临床护理质量和结果，它往往超出医疗保健的控制范围 组织(HCO)、HCO和临床医生一直被要求对护理质量和结果负责。 因此，当不考虑患者的SES时，可能会产生意想不到的负面后果 对卫生主任不利，特别是那些为弱势群体服务的卫生主任，因为它们影响到 联邦和州绩效工资计划下的责任申请(例如，支付)。 为了回应这些担忧，国家质量论坛(NQF)和国家质量论坛(National Quality Forum)发布的2017年报告 医学科学院(NAM)建议根据患者的SES调整HCO的性能。重要的是 虽然NAM和NQF都建议关于社会风险因素的数据应该尽可能细粒度，以 确保准确性，他们强调，关键是缺乏适用于个人层面的SES的措施 对HCO业绩进行准确的风险调整的挑战。一些个人级别的SES措施，如 可以获得医疗补助资格，但他们仍然不适合进行准确的风险调整，因为 集团内部的异质性和缺乏自己的SES的粒度。此外，聚合级别的SES衡量标准为 常规使用，但未能捕捉到一些质量护理措施与SES的关联。而当 明尼苏达州立法机构授权该州制定并报告合适的风险调整模式 为了解决健康差距，2017年明尼苏达州卫生部的质量报告系统风险 调整评估报告还认识到，缺乏个人层面的社会保障措施是一个重要的 有效和公平的风险调整的障碍以及现有综合水平的社会保障措施的局限性。 房屋(基于住房的SES)指数是一个经过验证的个人层面的SES指数，克服了这一不足 个人层面的SES措施，同时解决传统SES措施的局限性。 针对改进风险调整方法的挑战，我们建议1)实施住房 目前只在整个明尼苏达州的东南部MN县提供(目标1)；2) 确定2017年明尼苏达州社区评估(MNCM)中提供的绩效指标 报告对房屋衡量的社会经济状况敏感(目标2a)；以及3)改进风险调整 纳入患者住房的HCO绩效指标模型(目标2b)。建议数 研究将是在美国各地扩建房屋的不可或缺的一步，目的是解决 缺乏适当的个人层面的SES措施，这是国家一级应对适当风险的关键挑战 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，并为 绩效，2)对HCO的高价值关怀，以及3)社区伙伴关系。

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.