196388 Impact of risk adjustment on cross-sectional variations and short-term stability of the nursing home outcome measure of urinary/fecal incontinence

Tuesday, November 10, 2009: 1:15 PM

Yue Li, PhD , Department of Internal Medicine, University of Iowa & Iowa City VAMC, Iowa City, IA
John F. Schnelle, PhD , General Internal Medicine and Public Health, Vanderbilt University, Nashville, TN
William D. Spector, PhD , Agency for Healthcare Research & Quality, Rockville, MD
Laurent Glance, MD , Department of Anesthesiology, University of Rochester Medical Center, Rochester, NY
Dana B. Mukamel, PhD , Department of Medicine, Health Policy Research Institute, University of California, Irvine, Irvine, CA
The "Nursing Home Compare" report card publishes and regularly updates a set of outcome-based quality measures derived from resident health assessments. This study focused on one published measure (urinary/fecal incontinence rate of a nursing home), and tested whether multivariable risk adjustment for resident characteristics can improve (1) the validity of the measure for cross-sectional comparisons of nursing home quality, and (2) the short-term stability of the measure (ie, stability over 3 months). Our sample from the 2005 MDS included over 600,000 long-term care residents in 10,437 facilities. We estimated logistic regression models to predict the outcome rate for each resident based on his/her demographics and physical and mental health functions. We also tested the impact of "case mix" variation (ie, facility variation in patient characteristics) on both currently published and multivariable risk-adjusted measures. We found that at least 50% of the cross-sectional variation of the published measure was explained by that of facility case mix (R-square>=0.50), and over 25% of the short-term variation of the published measure was due to that of case mix (R-square>0.25). In contrast, the cross-sectional and short-term longitudinal variations of the risk-adjusted measure were much less susceptible to case mix variations (R-square<0.10). We conclude that multivariable risk adjustment through statistical regression can minimize the overall impact of case mix, and make the measure more likely to reflect a facility's cross-sectional standing and short-term stability in continence care practice (or quality). The risk-adjusted rate is more appropriate than unadjusted rate for use as a report card measure.

Learning Objectives:
Describe how risk adjustment improves the validity of one of the nursing home outcome measures currently published by CMS.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am trained in health services research and have been involved in research related to quality of care assessment and nursing home policy.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.