Risk Adjustment in Home and Community Based Services Outcome Measurement.
James Houseworth, Tina Kilaberia, Renata Ticha and 1 others
PMID 36188939WHAT IT FOUND
Current research on home and community-based services rarely uses risk adjustment, relying mostly on demographics.
Experts recommend testing chronic conditions, functional disability, mental health and cognition as key factors to adjust for in future outcome studies.
Key findings
01Risk adjustment is not a common practice in home and community-based services outcome research, despite being standard in healthcare reimbursement.
02The most frequently used individual-level risk adjusters in reviewed studies were functional disability and chronic conditions, while demographic factors like age and sex were also common.
03The study recommends that future investigations test chronic conditions, functional disability, mental health and cognition as primary risk adjusters.
STILL TO COME
How it was doneWhat they found
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What it does not show
The search strategy may have missed relevant studies. The definition of a 'risk adjuster' versus a 'covariate' is not clearly established in this field, which may have affected how variables were categorized. The reviewed literature was dominated by studies focusing on health and functioning outcomes, meaning the recommendations may not fully apply to social or employment outcomes. The study focused only on individual-level factors and did not assess system-level factors like funding or policy.
Declared interests
The work was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research. The authors declared no commercial or financial conflicts of interest.
The easy way to misread this
Do not treat the recommended risk adjusters as proven tools for evaluating your own clinic's outcomes. The authors state these factors need to be tested in future investigations, and current evidence shows that risk adjustment is not yet a standardized or common practice in home and community-based services research.