Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors

This project seeks to develop a set of recommendations on the inclusion of socioeconomic status (SES) and other factors such as race and ethnicity in risk adjustment for outcome and resource use performance measures. Read more

ACCESS FINAL REPORT - Project complete

Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors

Description

About the Project

This project will develop a set of recommendations related to risk adjustment for outcome and resource use performance measures, particularly for socioeconomic status (SES). The Expert Panel will analyze the issues and methodological considerations, as well as alternative solutions. The recommendations will address if, when, and how outcome and resource use performance measures should be adjusted for SES, race, and ethnicity. The recommendations also will address NQF’s measure evaluation criteria and guidance for endorsement as national voluntary consensus standards.

The Opportunity

Risk adjustment is the process of controlling for intrinsic patient factors that could influence outcomes used as performance measures for assessing healthcare services and providers. It is accepted practice to adjust for differences in patient severity of illness at the start of care because patients with more comorbidities and severity of illness are expected to have poorer outcomes than their more healthy counterparts. There is less agreement about adjusting for SES and inherent patient factors such as race, ethnicity, and gender that may be related to disparities in care.

Although empirical relationships between SES, race, and ethnicity and outcomes have been demonstrated, they may be confounded with quality of care issues (e.g., disparities in care practices or failing to provide patient-centered care based on those factors). NQF’s current measure evaluation criteria indicate that factors related to disparities in care should not be included in risk adjustment models for outcome performance measures; rather, performance measures should be stratified to identify disparities in care. In light of the continued use of and call for additional outcome performance measures, questions have arisen on the use, effects, and impact of including socioeconomic status in risk adjustment for outcome performance measures. In an environment of pay-for-performance and transparency of performance data, views on risk adjustment have become more polarized. There are at least two divergent views on adjusting for differences in SES, race, and ethnicity: 1) adjustment obscures potential problems in equitable care and outcomes, and 2) adjustment is essential for fair comparisons among providers of healthcare services when factors beyond their control influence patient outcomes. This work will build on NQF’s prior work on disparities.

NQF Process

This project will be guided by an expert panel. The panel will use relevant elements of NQF's Consensus Development Process to meet and review comments. However, as this project will not include the review and assessment of consensus standards, it will not include a member voting period.

Funding

This project is supported under a contract provided by the Department of Health and Human Services.

For information about the availability of auxiliary aids and services for NQF’s federally funded projects, please visit: http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.