Alternative Risk-Adjustment Approaches to Assessing the Quality of Home Health Care: Final Report. Empirical Research on Nursing Home Outcomes


There is a growing literature on risk-adjustment of nursing home quality measures. Mukamel and colleagues (2003), for example, used Minimum Data Set (MDS) information on over 45,000 residents in 671 nursing homes in New York State to develop a risk-adjusted urinary incontinence outcome measure. A large number of potential risk-adjusters was examined and goodness of fit statistics improved substantially when separate models were estimated for each of three age categories (i.e., 65-74, 75-84, and 85 and older). In earlier work, Mukamel and Brower (1998) examined the influence of three different risk-adjustment methods on conclusions about nursing home quality of care. The three methods examined were: (1) no risk-adjustment; (2) risk-adjustment using only items needed to determine nursing home payment (Resource Utilization Group, or RUGs, items); and (3) “comprehensive” adjustment based on patient-level risk factors. The investigators found substantial disagreement in quality ratings depending on the risk-adjustment method employed.

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