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Ideas and Opinions |21 October 2014

The Risks of Not Adjusting Performance Measures for Sociodemographic Factors

Steven H. Lipstein, MHA; W. Claiborne Dunagan, MD, MS

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
This article was published online first at www.annals.org on 22 July 2014.
  • From BJC HealthCare, St. Louis, Missouri.

    Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1601.

    Requests for Single Reprints: Steven H. Lipstein, MHA, BJC HealthCare, 4901 Forest Park Avenue, Suite 1200, St. Louis, MO 63108; e-mail, notestosteve@bjc.org.

    Current Author Addresses: Mr. Lipstein: BJC HealthCare, 4901 Forest Park Avenue, Suite 1200, St. Louis, MO 63108.

    Dr. Dunagan: BJC Center for Clinical Excellence, 8300 Eager Road, Suite 400A, St. Louis, MO 63144

    Author Contributions: Conception and design: S.H. Lipstein, W.C. Dunagan.

    Analysis and interpretation of the data: S.H. Lipstein, W.C. Dunagan.

    Drafting of the article: S.H. Lipstein, W.C. Dunagan.

    Critical revision of the article for important intellectual content: W.C. Dunagan.

    Final approval of the article: S.H. Lipstein, W.C. Dunagan.

    Statistical expertise: W.C. Dunagan.

    Administrative, technical, or logistic support: W.C. Dunagan.

    Collection and assembly of data: W.C. Dunagan.

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FULL TEXT
The National Quality Forum (NQF) recently convened an expert panel to make recommendations on a much-debated topic: whether to risk-adjust health care outcomes for sociodemographic factors present at the initiation of medical care and treatment. The panel completed its work in early July 2014, making the following recommendation:
The Centers for Medicare & Medicaid Services (CMS) has an opposing view, as reflected in the following comments from their director of quality measurement and health assessment posted on the NQF Web site after the expert panel's release of draft recommendations in March 2014:
The expert panel received 667 public comments from 158 organizations on this draft report: 143 supported the recommendations, 8 (including the CMS) opposed them, and 7 were mixed. Health care providers almost uniformly, along with some consumer advocates, supported the recommendations. They are concerned that, absent sociodemographic factor risk-adjustment methods that recognize a higher degree of difficulty and greater resource utilization in producing optimal quality outcomes for low-income and otherwise disadvantaged patients, safety-net providers are unfairly “tagged” with poorer health outcomes.
The “opposed” and “mixed” points of view came from purchasers, other consumer advocates, and measure developers. Purchasers and opposing consumer advocates are concerned about masking disparities in health outcomes, different standards of care, and the lack of transparency. Measure developers are concerned that risk adjustment for sociodemographic factors will burden their methods with added complexity and that data available in the public domain may be insufficient to do the necessary calculus and still produce reliable and valid...
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Lipstein SH, Dunagan WC. The Risks of Not Adjusting Performance Measures for Sociodemographic Factors. Ann Intern Med. 2014;161:594–596. doi: https://doi.org/10.7326/M14-1601

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Published: Ann Intern Med. 2014;161(8):594-596.

DOI: 10.7326/M14-1601

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