Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors

Risk adjustment—statistical methods to account for patient-related factors when computing outcome measures—is used to make more accurate evaluations about quality of care. NQF’s current policy recommends the adjustment of outcome measures for clinical factors, such as severity of illness and co-morbidities, recognizing that patients who are sicker and have multiple conditions have a higher likelihood of worse outcomes, regardless of the quality of care provided. Increasingly, policymakers and other leaders have raised the question of whether performance measures used in accountability applications, including public reporting and pay-for-performance, should be adjusted for sociodemographic factors in order to improve the accuracy of performance results. There is a substantial body of evidence that sociodemographic factors influence a variety of patient outcomes and some processes. Two accountability measures in particular have brought this discussion to the forefront: Hospital-wide All-cause Unplanned Readmissions and Medicare Spending per Beneficiary Measure. NQF’s current criteria do not allow adjusting performance measures for sociodemographic factors, out of a desire to make disparities visible in order to motivate efforts to improve care for disadvantaged populations. Rather, NQF policy recommends that performance measures be stratified – or calculated separately-- by sociodemographic factors, e.g., income, race, education etc to make those differences visible. To answer the question “what, if anything should be done about sociodemographic factors in relation to outcome performance measurement, ” NQF convened an Expert Panel of 26 individuals with a variety of expertise related to disparities, performance measurement and risk adjustment methods, as well as varied stakeholders (e.g., consumers, purchasers and providers). This project is funded by HHS