The Risks of Not Adjusting Performance Measures for Sociodemographic Factors
Authors: Steven H. Lipstein, W. Claiborne Dunagan
Journal: Annals of Internal Medicine (2014)

Ideas and Opinions21 October 2014The Risks of Not Adjusting Performance Measures for Sociodemographic FactorsSteven H. Lipstein, MHA and W. Claiborne Dunagan, MD, MSSteven H. Lipstein, MHAFrom BJC HealthCare, St. Louis, Missouri.Search for more papers by this author and W. Claiborne Dunagan, MD, MSFrom BJC HealthCare, St. Louis, Missouri.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-1601 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The National Quality Forum (NQF) recently convened an expert panel to make recommendations on a much-debated topic: whether to risk-adjust health care outcomes for sociodemographic factors present at the initiation of medical care and treatment. The panel completed its work in early July 2014, making the following recommendation:When there is a conceptual relationship (i.e., logical rationale or theory) between sociodemographic factors and outcomes or processes of care and empirical evidence (e.g., statistical analysis) that sociodemographic factors affect an outcome or process of care reflected in a performance measure: those sociodemographic factors should be included in risk adjustment of the ...References1. National Quality Forum. Risk adjustment for sociodemographic factors. 2014. Accessed at www.qualityforum.org/Risk_Adjustment_SES.aspx on 8 July 2014. Google Scholar2. Neuhausen K, Davis AC, Needleman J, Brook RH, Zingmond D, Roby DH. Disproportionate-share hospital payment reductions may threaten the financial stability of safety-net hospitals. Health Aff (Millwood). 2014;33:988-96. [PMID: 24889948] doi:10.1377/hlthaff.2013.1222 CrossrefMedlineGoogle Scholar3. Council of Economic Advisers. Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid. Washington, DC: Executive Office of the President of the United States; 2014. Accessed at www.whitehouse.gov/sites/default/files/docs/missed_opportunities_medicaid.pdf on 9 July 2014. Google Scholar4. Casalino LP, Elster A, Eisenberg A, Lewis E, Montgomery J, Ramos D. Will pay-for-performance and quality reporting affect health care disparities? Health Aff (Millwood). 2007;26:w405-14. [PMID: 17426053] CrossrefMedlineGoogle Scholar5. Joynt KE, Jha AK. A path forward on Medicare readmissions. N Engl J Med. 2013;368:1175-7. [PMID: 23465069] doi:10.1056/NEJMp1300122 CrossrefMedlineGoogle Scholar6. Hu J, Gonsahn MD, Nerenz DR. Socioeconomic status and readmissions: evidence from an urban teaching hospital. Health Aff (Millwood). 2014;33:778-85. [PMID: 24799574] doi:10.1377/hlthaff.2013.0816 CrossrefMedlineGoogle Scholar7. Nagasako EM, Reidhead M, Waterman B, Dunagan WC. Adding socioeconomic data to hospital readmissions calculations may produce more useful results. Health Aff (Millwood). 2014;33:786-91. [PMID: 24799575] doi:10.1377/hlthaff.2013.1148 CrossrefMedlineGoogle Scholar8. Pear R. Health law's pay policy is skewed, panel finds. The New York Times. 28 April 2014:A13. Accessed at www.nytimes.com/2014/04/28/us/politics/health-laws-pay-policy-is-skewed-panel-finds.html on 7 July 2014. Google Scholar9. Thomas L. Poor Health special report: hospitals, doctors moving out of poor city neighborhoods to more affluent areas. Milwaukee Journal Sentinel. 14 June 2014. Accessed at www.jsonline.com/news/health/hospitals-doctors-moving-out-of-poor-city-neighborhoods-to-more-affluent-areas-b99284882z1-262899701.html on 9 July 2014. Google Scholar Author, Article, and Disclosure InformationAuthors: Steven H. Lipstein, MHA; W. Claiborne Dunagan, MD, MSAffiliations: From BJC HealthCare, St. Louis, Missouri.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-1601.Corresponding Author: Steven H. Lipstein, MHA, BJC HealthCare, 4901 Forest Park Avenue, Suite 1200, St. Louis, MO 63108; e-mail, [email protected]org.Current Author Addresses: Mr. Lipstein: BJC HealthCare, 4901 Forest Park Avenue, Suite 1200, St. Louis, MO 63108.Dr. Dunagan: BJC Center for Clinical Excellence, 8300 Eager Road, Suite 400A, St. Louis, MO 63144Author Contributions: Conception and design: S.H. Lipstein, W.C. Dunagan.Analysis and interpretation of the data: S.H. Lipstein, W.C. Dunagan.Drafting of the article: S.H. Lipstein, W.C. Dunagan.Critical revision of the article for important intellectual content: W.C. Dunagan.Final approval of the article: S.H. Lipstein, W.C. Dunagan.Statistical expertise: W.C. Dunagan.Administrative, technical, or logistic support: W.C. Dunagan.Collection and assembly of data: W.C. Dunagan.This article was published online first at www.annals.org on 22 July 2014. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byReadmission After ACS: Burden, Epidemiology, and MitigationKeys to Driving Implementation of the New Kidney Care ModelsResidual Confounding in Health Plan Performance Assessments: Evidence From Randomization in MedicaidJacob Wallace, PhD, J. Michael McWilliams, MD, PhD, Anthony Lollo, PhD, Janet Eaton, BS, and Chima D. 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