Risk adjustment for home and community-based services quality measurement
Key Points
- Impact statement: Home and community-based support services enable persons with disabilities to live in the community. Growing demand for services has increased efforts to measure service quality and effectiveness. In this brief, we provide a non-technical overview of risk-adjustment to improve outcomes.
- States and other entities paying for home and community-based services want to understand which types of services or service arrangements optimize person-centered outcomes.
- For comparing the outcomes of home and community-based services across providers or service arrangements, risk adjustment is warranted for some quality outcome measures.
- Risk adjustment can be accomplished through the application of exclusion criteria, stratification, and the use of regression model results.
Abstract
Home and community-based services are support services provided to persons with disabilities that enable them to live in the community. The growing demand for home and community-based services has led to an increase in efforts to measure the quality, including the effectiveness, of these services and supports in helping people to achieve their desired health and quality-of-life outcomes. Quality measures that focus on outcomes may need to be risk adjusted. This is because each provider serves a unique mix of persons with varying characteristics, and a provider’s case-mix can confound their outcomes. In this brief, we provide a nontechnical description of the purpose of risk adjustment in quality measurement and approaches to risk adjust data, including applying exclusion criteria, stratification, and the use of regression model results.
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