Risk adjustment methods can affect perceptions of outcomes
Department of Quantitative Health Sciences
Medical Subject Headings
Adolescent; Adult; Aged; Aged, 80 and over; *Data Interpretation, Statistical; Diagnosis-Related Groups; Hospital Mortality; Humans; Logistic Models; Medicaid; Medicare; Middle Aged; *Models, Statistical; Myocardial Infarction; *Outcome Assessment (Health Care); Predictive Value of Tests; Risk Factors; *Severity of Illness Index; United States
Biostatistics | Epidemiology | Health Services Research
When comparing outcomes of medical care, it is essential to adjust for patient risk, including severity of illness. A variety of severity measures exist, but perceptions of outcomes may differ depending on how severity is defined. We used two severity-adjustment approaches to demonstrate that comparisons of outcomes across subgroups of patients can vary dramatically depending on how severity is assessed. We studied two approaches: model 1 was the admission MedisGroups score; model 2 was computed from age and 12 chronic conditions defined by diagnosis codes. Although common summary measures of model performance (R-squared and C) both suggested that model 1 is a better predictor of in-hospital death than model 2, the weaker model consistently produced more accurate expectations by payer class and age group. Using model 1 for severity adjustment suggested that Medicare patients did substantially worse than expected and Medicaid patients substantially better. In contrast, use of model 2 found Medicare patients doing as expected, but Medicaid patients faring poorly.
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Citation: Am J Med Qual. 1994 Summer;9(2):43-8. Link to article on publisher's site
Iezzoni, Lisa I.; Shwartz, Michael; Ash, Arlene S.; Mackiernan, Yevgenia D.; and Hotchkin, Elizabeth K., "Risk adjustment methods can affect perceptions of outcomes" (1994). Quantitative Health Sciences Publications and Presentations. 635.