Alternative Risk-Adjustment Approaches to Assessing the Quality of Home Health Care: Final Report. Project Framework


The framework for selecting the core set of risk-adjusters is based on an integration of Iezzoni’s conceptual model, prior empirical research, and the input of a Technical Advisory Group (TAG) (see below). It is limited to patient measures although the context in which care is provided theoretically may influence patient outcomes. The specific domains and sub-domains of potential risk-adjusters are listed below and refer to patient status at the time of home health admission (or at the time of a subsequent baseline assessment) unless otherwise indicated:

  • Demographic characteristics.
  • Socioeconomic factors:
    • Health insurance coverage;
    • Housing and neighborhood characteristics;
    • Familial characteristics, household composition and support/assistance in the home;
    • Educational attainment and health literacy;
    • Economic resources;
    • Employment and occupation;
    • Cultural beliefs and behaviors.
  • Clinical factors:
    • Clinical status before and leading up to home care admission:
      • Historical use of health services,
      • Prior medical conditions,
      • Prior physical functioning;
    • Clinical status at home care admission:
      • Physiologic measures,
      • Primary diagnosis and comorbidities,
      • Physical functioning,
      • Cognitive status,
      • Mental health;
    • Clinical therapies at home care admission.
  • Health-related behaviors and activities.
  • Attitudes and perceptions.

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