Alternative Risk-Adjustment Approaches to Assessing the Quality of Home Health Care: Final Report. TABLE 8b: Final Alternative Risk-Adjustment Models for Physiologic Outcomes

07/01/2006

TABLE 8b. Final Alternative Risk-Adjustment Models for Physiologic Outcomes (Part I)
Risk Factor Measured at SOC/ROC Improvement in:
Pain No. of Surg. Wounds Status of Surg. Wonds Dyspnea Urinary Tract Infection Urinary Incontinence
Full Model Core Only Core Only Full Model Full Model Full Model
Coef. p Coef. p Coef. p Coef. p Coef. p Coef. p
DEMOGRAPHICS
Age lt 65  -0.182   0.000   -0.095   0.002   -0.202   0.000   -0.014   0.417   -0.069   0.319   -0.204   0.000 
Age 75-84 0.095 0.000 0.110 0.000 0.139 0.000 -0.022 0.068 0.018 0.703 -0.015 0.418
Age 85+ 0.141 0.000 0.285 0.000 0.340 0.000 -0.066 0.000 -0.045 0.399 -0.106 0.000
Gender: female -0.114 0.000 0.084 0.000 0.137 0.000 0.038 0.000 0.055 0.167 -0.059 0.000
SOCIOECONOMIC FACTORS
Any Medicaid -0.077 0.001 -0.036 0.292 0.004 0.913 -0.101 0.000 -0.041 0.506 -0.109 0.000
Medicare HMO -0.132 0.000 -0.240 0.000 -0.268 0.000 0.128 0.000 -0.171 0.002 0.138 0.000
PRIOR SERVICE USE
Discharged past 14 days:
Discharge from hospital 0.117 0.000 -0.042 0.133 0.071 0.029 0.286 0.000 0.350 0.000 0.310 0.000
Discharge from rehab facility 0.091 0.000 0.165 0.000 0.117 0.002 0.423 0.000 0.674 0.000 0.396 0.000
Discharge from nursing home -0.061 0.012 -0.080 0.040 -0.110 0.013 0.266 0.000 0.545 0.000 0.221 0.000
CLINICAL FACTORS
Prognoses
Overall prognosis good/fair 0.286 0.000 0.073 0.264 0.256 0.000 0.251 0.000 0.147 0.034 0.091 0.001
Rehabilitation prognosis good 0.289 0.000 -0.110 0.005 -0.045 0.317 0.256 0.000 0.054 0.263 0.164 0.000
Diagnoses
Diabetes (PPS Group) 0.023 0.180 0.038 0.133 -0.082 0.004 -0.050 0.000 0.053 0.238 -0.036 0.042
Orthopedic (PPS Group) -0.215 0.000 0.126 0.000 0.168 0.000 0.257 0.000 0.353 0.000 0.089 0.000
Neurological (PPS Group) 0.034 0.092 0.089 0.017 0.102 0.017 0.139 0.000 0.250 0.000 -0.086 0.000
Wound/Burn (PPS Group) 0.088 0.002 -0.027 0.422 -0.107 0.005 -0.191 0.000 0.304 0.006 -0.151 0.000
Cancer -0.086 0.000 -0.061 0.037 -0.151 0.000 -0.163 0.000 0.006 0.924 -0.056 0.040
Mental condition 0.067 0.055 0.031 0.618 0.093 0.186 0.032 0.181 0.058 0.527 0.000 0.993
Dementia 0.167 0.000 -0.004 0.968 -0.017 0.895 0.109 0.000 -0.050 0.563 -0.024 0.436
Hypertension 0.085 0.000 0.074 0.001 0.111 0.000 0.004 0.691 0.161 0.000 0.010 0.519
Ischemia 0.093 0.000 -0.205 0.000 -0.048 0.110 -0.017 0.210 0.147 0.022 0.040 0.089
Arrhythmia 0.090 0.000 0.141 0.000 0.169 0.000 -0.020 0.199 0.050 0.441 0.033 0.182
Heart failure -0.056 0.010 0.266 0.000 0.209 0.000 -0.156 0.000 0.257 0.000 -0.022 0.268
COPD -0.004 0.873 0.156 0.000 0.164 0.000 -0.327 0.000 0.282 0.000 0.015 0.517
Skin ulcer 0.083 0.006 -0.092 0.020 -0.236 0.000 -0.140 0.000 0.185 0.053 -0.100 0.002
Orthopedic (other than PPS) -0.293 0.000 0.047 0.038 0.238 0.000 0.195 0.000 0.177 0.000 0.005 0.783
Incontinence -0.072 0.109 0.111 0.261 0.276 0.023 -0.194 0.000 -0.050 0.544 -0.234 0.000
Symptoms, signs, & ill-defined conditions -0.047 0.047 0.149 0.001 0.111 0.031 0.045 0.005 0.044 0.435 -0.016 0.473
Diagnosis Severity
Number of severity ratings >2 0.011 0.031 0.049 0.000 0.025 0.004 -0.037 0.000 0.033 0.012 -0.003 0.584
Sensory Status
Partially vision impaired 0.028 0.072 0.204 0.000 0.166 0.000 -0.189 0.000 -0.080 0.049 -0.055 0.000
Severely vision impaired 0.046 0.302 0.189 0.033 0.259 0.015 -0.157 0.000 -0.025 0.803 -0.020 0.600
Speech: Minimum difficulty 0.040 0.046 0.154 0.000 0.112 0.006 -0.056 0.000 0.053 0.292 -0.048 0.011
Speech: Moderate difficulty 0.194 0.000 0.144 0.065 0.244 0.009 -0.005 0.843 0.089 0.266 -0.092 0.001
Speech: Severe difficulty 0.317 0.000 0.236 0.015 0.113 0.302 -0.034 0.322 0.051 0.604 -0.167 0.000
Speech: Severe difficulty/unable (Levels 3, 4)                        
Speech: Severe difficulty/unable/non-responsive (Levels 3-5)                        
Integumentary Status
Surgical wound present 0.155 0.000         0.276 0.000 0.214 0.000 0.140 0.000
Stage of most problematic pressure ulcer -0.073 0.000 0.116 0.000 0.089 0.002 -0.023 0.044 0.045 0.259 -0.107 0.000
Status of most problematic stasis ulcer -0.075 0.000 0.102 0.016 -0.023 0.613 -0.052 0.000 0.304 0.001 -0.009 0.662
2 surgical wounds     0.662 0.000                
3 surgical wounds     0.881 0.000                
4 surgical wounds     0.542 0.000                
Surg Wnd Status: Early/partial granulation         0.972 0.000            
Surg Wnd Status: Not healing         1.889 0.000            
Functional Status/Physical Functioning
ADL/IADL index -0.012 0.000 0.042 0.000 0.041 0.000 0.004 0.041 0.061 0.000 -0.016 0.000
Toilet: Able when supervised                     0.146 0.000
Toilet: Uses bedside commode                     0.164 0.000
Toilet: Uses bedpan independently                        
Toilet: Totally dependent                        
Toilet: Uses bedpan indep/totally dependent                     -0.058 0.165
Amb: Needs device to walk                 -0.048 0.431    
Amb: Needs assistance to walk                 -0.164 0.050    
Amb: Chairfast or Bedfast (Levels 3-5)                 -0.336 0.000    
Elimination Status
Urinary incontinence during the night -0.072 0.003 -0.016 0.710 -0.025 0.615 -0.057 0.001 -0.116 0.088    
Urinary incontinence during the day 0.081 0.073 0.015 0.868 -0.071 0.494 -0.070 0.027 0.004 0.977 0.257 0.000
Urinary incontinence during the night & day -0.049 0.013 0.052 0.149 0.015 0.731 -0.181 0.000 -0.137 0.016 0.087 0.000
Urinary catheter present -0.019 0.586 0.103 0.039 0.025 0.662 -0.168 0.000 -0.703 0.000 0.284 0.000
Bowel incontinent less than weekly -0.039 0.352 0.081 0.360 -0.069 0.493 0.007 0.810 0.118 0.210 -0.110 0.000
Bowel incontinent 1-3 times/week -0.057 0.147 0.062 0.476 -0.019 0.847 -0.071 0.007 -0.094 0.213 -0.285 0.000
Bowel incontinent 4-6 times/week -0.006 0.920 0.141 0.286 0.124 0.427 -0.071 0.078 -0.014 0.888 -0.410 0.000
Bowel incontinent daily or more often 0.097 0.028 0.047 0.591 0.085 0.405 -0.032 0.302 -0.108 0.166 -0.384 0.000
Ostomy 0.213 0.000 0.330 0.000 0.134 0.023 0.059 0.089 -0.005 0.965 -0.305 0.000
Neuro/Emotional/Behavioral Status
Cog Func: Requires prompting 0.016 0.465 0.010 0.788 0.024 0.577 -0.050 0.001 -0.033 0.546 -0.067 0.001
Cog Func: Requires assistance & some direction 0.102 0.004 -0.061 0.397 -0.084 0.313 0.034 0.149 -0.066 0.420 -0.099 0.001
Cog Func: Requires considerable assistance -0.013 0.830 -0.072 0.600 -0.087 0.585 0.045 0.256 -0.264 0.020 -0.165 0.000
Cog Func: Totally dependent -0.183 0.124 -0.168 0.553 -0.182 0.585 -0.150 0.061 0.120 0.525 -0.176 0.019
Conf Freq: In new situations -0.009 0.633 0.074 0.011 0.093 0.006 -0.101 0.000 -0.047 0.328 -0.071 0.000
Conf Freq: Awakening at night -0.024 0.652 0.069 0.540 0.005 0.972 -0.038 0.288 0.000 0.998 -0.108 0.014
Conf Freq: Day/evenings, not constant 0.084 0.014 0.059 0.399 -0.006 0.945 -0.067 0.003 0.025 0.747 -0.112 0.000
Conf Freq: Constantly 0.301 0.000 -0.038 0.816 -0.042 0.825 0.076 0.093 -0.130 0.285 -0.241 0.000
Anx Freq: Less than daily -0.071 0.000 0.025 0.312 0.005 0.866 -0.124 0.000 0.015 0.725 -0.057 0.001
c statistic -0.169 0.000 -0.041 0.171 -0.052 0.134 -0.131 0.000 -0.087 0.081 0.006 0.750
Anx Freq: All the time -0.153 0.003 -0.166 0.069 -0.063 0.548 -0.091 0.010 -0.235 0.055 0.020 0.686
Verbal disruption -0.007 0.917 -0.010 0.941 -0.089 0.571 -0.071 0.095 -0.081 0.514 -0.065 0.155
Depressive Feelings: Depressed mood -0.108 0.000 -0.013 0.639 -0.031 0.315 -0.029 0.013 0.052 0.241 -0.019 0.256
Depressive Feelings: Any other elements (2-6) -0.215 0.000 -0.031 0.711 -0.169 0.069 -0.089 0.001 0.206 0.058 0.045 0.219
OUTCOME SPECIFIC RISK-ADJUSTERS
Smoking             -0.101 0.000        
Obesity             -0.204 0.000 -0.049 0.334 -0.074 0.000
Pain daily but not constantly 0.229 0.000                    
Pain all the time 1.701 0.000                    
Dyspnea when moderate exertion             1.022 0.000        
Dyspnea with minimum exertion             1.619 0.000        
Dyspnea when at rest             2.187 0.000        
Intractable pain -0.256 0.000                    
Memory deficit                     -0.083 0.000
Impaired decision making                     -0.034 0.121
Status Prior to Admission
Toilet: Able when supervised                     -0.223 0.000
Toilet: Uses bedside commode                     -0.338 0.000
Toilet: Uses bedpan indep/totally dependent (Levels 3, 4)                     -0.511 0.000
Urinary incontinence prior 2 weeks                 -0.097 0.045 -0.358 0.000
Indwelling/suprapubic catheter prior 2 weeks                 -0.113 0.107 -0.629 0.000
Intractable pain prior 2 weeks -0.262 0.000                    
Impaired decision making prior 2 weeks                     -0.052 0.018
Memory loss prior 2 weeks                     0.011 0.630
Clinical Factors: Therapies
Oxygen therapy             -0.719 0.000        
IV/Infusion therapy                 -1.098 0.000    
Ventilator             -1.203 0.000        
Urinary Tract Infection                     -0.082 0.000
 
Intercept -0.381 0.000 -0.396 0.000 -0.406 0.000 -0.901 0.000 0.609 0.000 0.360 0.000
R2 statistic 0.058   0.047   0.065   0.110   0.059   0.103  
c statistic 0.635   0.626   0.670   0.690   0.665   0.682  

 

TABLE 8b. Final Alternative Risk-Adjustment Models for Physiologic Outcomes (Part II)
Risk Factor Measured at SOC/ROC Improvement in: Stabilization in:
Bowel Incontinence Speech Speech
Full Model Core Only Core Only
Coef. p Coef. p Coef. p
DEMOGRAPHICS
Age lt 65  -0.209   0.000   -0.174   0.000   0.030   0.417 
Age 75-84 0.042 0.229 0.054 0.037 -0.112 0.000
Age 85+ -0.012 0.748 0.015 0.604 -0.349 0.000
Gender: female -0.010 0.684 0.107 0.000 0.100 0.000
SOCIOECONOMIC FACTORS
Any Medicaid -0.141 0.000 -0.226 0.000 -0.155 0.000
Medicare HMO 0.084 0.049 0.099 0.003 -0.024 0.417
PRIOR SERVICE USE
Discharged past 14 days:
Discharge from hospital 0.231 0.000 0.398 0.000 0.227 0.000
Discharge from rehab facility 0.335 0.000 0.488 0.000 0.203 0.000
Discharge from nursing home 0.275 0.000 0.265 0.000 0.063 0.057
CLINICAL FACTORS
Prognoses
Overall prognosis good/fair 0.040 0.273 0.089 0.010 0.214 0.000
Rehabilitation prognosis good 0.125 0.000 0.075 0.002 0.187 0.000
Diagnoses
Diabetes (PPS Group) 0.009 0.774 0.047 0.050 -0.014 0.538
Orthopedic (PPS Group) 0.126 0.000 0.163 0.000 0.248 0.000
Neurological (PPS Group) -0.073 0.007 -0.202 0.000 -0.347 0.000
Wound/Burn (PPS Group) -0.007 0.900 -0.043 0.338 -0.041 0.340
Cancer -0.069 0.198 0.019 0.618 -0.148 0.000
Mental condition 0.056 0.312 -0.139 0.000 -0.318 0.000
Dementia -0.054 0.198 -0.321 0.000 -0.416 0.000
Hypertension 0.058 0.045 -0.008 0.719 0.021 0.314
Ischemia -0.020 0.669 0.042 0.175 0.171 0.000
Arrhythmia 0.022 0.646 0.042 0.208 0.022 0.496
Heart failure 0.053 0.162 0.047 0.090 -0.024 0.0363
COPD 0.034 0.468 0.1113 0.000 0.110 0.000
Skin ulcer -0.065 0.192 -0.039 0.389 -0.047 0.261
Orthopedic (other than PPS) 0.017 0.627 0.090 0.000 0.360 0.000
Incontinence -0.219 0.000 -0.036 0.480 0.014 0.787
Symptoms, signs, & ill-defined conditions -0.042 0.261 -0.018 0.539 -0.036 0.222
Diagnosis Severity
Number of severity ratings >2 0.024 0.012 0.013 0.081 -0.024 0.001
Sensory Status
Partially vision impaired -0.015 0.571 -0.072 0.000 -0.070 0.001
Severely vision impaired -0.001 0.983 0.040 0.432 -0.090 0.081
Speech: Minimum difficulty 0.049 0.177     1.480 0.000
Speech: Moderate difficulty -0.024 0.592 0.936 0.000 2.115 0.000
Speech: Severe difficulty -0.169 0.001        
Speech: Severe difficulty/unable (Levels 3, 4)         2.770 0.000
Speech: Severe difficulty/unable/non-responsive (Levels 3-5)     1.054 0.000    
Integumentary Status
Surgical wound present 0.103 0.006 0.222 0.000 0.468 0.000
Stage of most problematic pressure ulcer -0.094 0.000 -0.025 0.246 -0.007 0.709
Status of most problematic stasis ulcer -0.017 0.637 -0.046 0.095 0.035 0.181
2 surgical wounds            
3 surgical wounds            
4 surgical wounds            
Surg Wnd Status: Early/partial granulation            
Surg Wnd Status: Not healing            
Functional Status/Physical Functioning
ADL/IADL index -0.087 0.000 -0.048 0.000 -0.113 0.000
Toilet: Able when supervised 0.256 0.000        
Toilet: Uses bedside commode 0.285 0.000        
Toilet: Uses bedpan independently 0.211 0.027        
Toilet: Totally dependent -0.066 0.361        
Toilet: Uses bedpan indep/totally dependent            
Amb: Needs device to walk            
Amb: Needs assistance to walk            
Amb: Chairfast or Bedfast (Levels 3-5)            
Elimination Status
Urinary incontinence during the night -0.192 0.000 -0.093 0.004 -0.081 0.015
Urinary incontinence during the day -0.208 0.007 -0.221 0.000 -0.141 0.012
Urinary incontinence during the night & day -0.398 0.000 -0.189 0.000 -0.125 0.000
Urinary catheter present -0.496 0.000 -0.176 0.000 0.000 0.993
Bowel incontinent less than weekly     -0.084 0.075 -0.060 0.242
Bowel incontinent 1-3 times/week -0.098 0.003 -0.104 0.011 -0.165 0.000
Bowel incontinent 4-6 times/week 0.230 0.000 -0.234 0.000 -0.283 0.000
Bowel incontinent daily or more often 0.468 0.000 -0.181 0.000 -0.340 0.000
Ostomy     0.028 0.723 0.062 0.356
Neuro/Emotional/Behavioral Status
Cog Func: Requires prompting 0.017 0.680 -0.366 0.000 -0.544 0.000
Cog Func: Requires assistance & some direction -0.045 0.365 -0.661 0.000 -0.963 0.000
Cog Func: Requires considerable assistance -0.020 0.739 -0.774 0.000 -1.104 0.000
Cog Func: Totally dependent 0.009 0.915 -0.815 0.000 -0.936 0.000
Conf Freq: In new situations -0.128 0.001 -0.158 0.000 -0.486 0.000
Conf Freq: Awakening at night -0.084 0.247 -0.084 0.144 -0.586 0.000
Conf Freq: Day/evenings, not constant -0.147 0.003 -0.350 0.000 -0.762 0.000
Conf Freq: Constantly -0.274 0.000 -0.473 0.000 -0.993 0.000
Anx Freq: Less than daily -0.009 0.763 0.000 0.991 0.004 0.875
c statistic 0.045 0.170 0.042 0.101 0.038 0.151
Anx Freq: All the time 0.072 0.360 0.092 0.158 0.013 0.851
Verbal disruption -0.152 0.006 -0.131 0.023 -0.196 0.002
Depressive Feelings: Depressed mood -0.028 0.338 0.021 0.356 -0.046 0.045
Depressive Feelings: Any other elements (2-6) 0.070 0.240 0.138 0.004 0.023 0.663
OUTCOME SPECIFIC RISK ADJUSTERS
Smoking            
Obesity -0.004 0.915        
Pain daily but not constantly            
Pain all the time            
Dyspnea when moderate exertion            
Dyspnea with minimum exertion            
Dyspnea when at rest            
Intractable pain            
Memory deficit -0.088 0.007        
Impaired decision making -0.007 0.837        
Status Prior to Admission
Toilet: Able when supervised -0.309 0.000        
Toilet: Uses bedside commode -0.330 0.000        
Toilet: Uses bedpan indep/totally dependent (Levels 3, 4) -0.574 0.000        
Urinary incontinence prior 2 weeks -0.138 0.000        
Indwelling/suprapubic catheter prior 2 weeks -0.161 0.014        
Intractable pain prior 2 weeks            
Impaired decision making prior 2 weeks -0.126 0.000        
Memory loss prior 2 weeks 0.086 0.015        
Clinical Factors: Therapies
Oxygen therapy            
IV/Infusion therapy            
Ventilator            
Urinary Tract Infection 0.017 0.619        
 
Intercept 1.685 0.000 -0.030 0.586 2.719 0.000
R2 statistic 0.131   0.080   0.085  
c statistic 0.711   0.665   0.742  

 

View full report

Preview
Download

"qualHH.pdf" (pdf, 3.72Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®