An Examination of Methods for Risk-Adjustment of Rehospitalization Rates
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This study examines three methods of conducting risk-adjustment to determine if the choice of method results in different conclusions about comparative mental health center performance. The three methods of risk-adjustment are stratification-weighting, logistic regression without interaction effects, and logistic regression with interaction effects. The dependent variable of interest is psychiatric rehospitalization within 14–60 days of discharge to a community mental health center. Subjects are adults discharged in fiscal year 1998 from inpatient psychiatric care to a designated community mental health center in Oklahoma. Using each method, we examine the mental health centers to determine whether their rehospitalization rates are significantly greater than, less than, or not different from, expected. Results show that, for some agencies, method of risk adjustment leads to different conclusions about center performance. Results are discussed with respect to identifying the preferred method of risk-adjustment, study limitations, and next steps in developing risk-adjustment technology and applications.
- Banks, S. M., Pandiani, J. A., Gauvin, L., Reardon, E. M., Schacht, L., & Zovistoski, A. P. (1998). Practice patternsand hospitalization rates. Administration and Policy in Mental Health, 26(1), 33–44.
- Banks, S. M., Pandiani, J. A., Schacht, L., & Gauvin, L. (1999). A risk-adjusted measure of hospitalization rates for evaluating community mental health program performance. Administration and Policy in Mental Health, 26(4), 269–279.
- Chisholm, D., Knapp, M., Astin, J., Lelliott, P., & Audini, B. (1997). The mental health residential care study: predicting costs from resident characteristics. British Journal of Psychiatry, 170, 37–42.
- DesHarnais, S., McMahon, L. F., & Wroblewski, R. (1991). Measuring outcomes of hospital care using multiple risk-adjusted indexes. Health Services Research, 26(4), 425–445.
- Dow, M. G., Boaz, T. L., & Thornton, D. (in press). Risk adjustment of Florida mental health outcomes data: Concepts, methods, and results. Journal of Behavioral Health Services and Research.
- Eddy, D. M. (1998). Performance measurement: Problems and solutions. Health Affairs, 17(4), 7–25.
- Ellis, R. P., & Ash, A. (1995). Refinements to the diagnostic cost group (DCG) model. Inquiry, 32, 418–429.
- Ettner, S., & Notman, E. H. (1997). How well do ambulatory care groups predict expenditures on mental health and substance abuse patients. Administration and Policy in Mental Health, 24(4), 339–357.
- Fowles, J.B., Weiner, J. P., Knutson, D., Fowler, E., Tucker, A. M., & Ireland, M. (1996). Taking health status into account when setting capitation rates: A comparison of risk-adjustment methods. JAMA, 276, 1316–1321.
- Hendryx, M. (2000). Mental health information needs: Risks and outcomes. Paper presented at the National Association of Health Data Organizations 14th Annual National Meeting, Pittsburgh.
- Hendryx, M., Dyck, D., & Srebnik, D. (1999). Risk-adjusted outcome models for public mental health outpatient programs. Health Services Research, 34, 171–195.
- Iezzoni, L. (ed). (1994). Risk-adjustment for measuring health care outcomes. Ann Arbor: Health Administration Press.
- Kramer, T. L., Daniels, A. S., Zieman, G. L., Williams C, & Dewan, N. A. (2000). Psychiatric practice variations in the diagnosis and treatment of major depression. Psychiatric Services, 51(3), 336–340.
- Mental Health Statistics Improvement Program Report Card Phase II Task Force (MHSIP Task Force). (1996). The MHSIP Consumer-Oriented Mental Health Report Card. Rockville, MD: Center for Mental Health Services.
- National Association of State Mental Health Program Directors Research Institute, (NASMHPD-NRI). (1998). Five state feasibility study on state mental health agency performance measures. Draft final report, June 1998. Prepared for U.S. Center for Mental Health Services. Alexandria, VA: NASMHPD-NRI.
- Newman, F. L., DeLiberty, R. N., & Ward, E. O. (1999). Hoosier Assurance Plan IV: Consumer progress/outcomes by risk adjustment group for those enrolled for more than 3 years. Paper presented at the 6th Annual Florida Conference on Behavioral Healthcare Evaluation, Orlando, Fl.
- Pandiani, J. A., & Banks, S. M. (1998). Methodology for statistical adjustment/correction of survey results. Vermont Mental Health Statistics Improvement Project.
- Payne, S., Cebul, R.D., Singer M. E., Krishnaswamy, J., & Gharrity, K. (2000). Comparison of risk-adjustment systems for the Medicaid-eligible disabled population. Medical Care, 38, 422–432.
- Pincus, H. A., Zarin, D. A., & West, J. C. (1996). Peering into the ‘black box’: Measuring outcomes of managed care. Archives of General Psychiatry, 53, 870–877.
- Poses, R. M., McClish, D. K., Smith, W. R., Huber, E. C., Clemo F., Schmitt, B. P., Alexander D., Racht, E. M., & Colenda, C. C. (2000). Results of report cards for patients with congestive heart failure depend on the method used to adjust for severity. Annals of Internal Medicine, 133, 10–20.
- Rubin, D. B. (1997). Estimating causal effects from large data sets using propensity scores. Annals of Internal Medicine, 127, 757–763.
- Shah, B. V., Barnwell, B.G., & Bieler, G. S. (1997). SUDAAN user's Manual, Release 7.5. Research Triangle Park, NC: Research Triangle Institute.
- Shapiro, M. F., Park, R. E., Keesey, J., & Brook, R. H. (1994). The effect of alternative case-mix adjustments on mortality differences between municipal and voluntary hospitals in New York City. Health Services Research, 29(1), 95–112.
- Stearns, S. C., & Slifkin, R. T. (1995). State risk pools and mental health care use. Health Affairs, 14(3), 185–196.
- Teague, G. B., Ganju, V., Hornik, J. A., Johnson, J. R., & McKinney, J. (1997). The MHSIP Mental Health Report Card. A consumer-oriented approach to monitoring the quality of mental health plans. Evaluation Review, 21(3), 330–341.
- Thomas, J. W., & Hofer, T. P. (1998). Research evidence on the validity of risk-adjusted mortality rate as a measure of hospital quality of care. Medical Care Research and Review, 55(4), 371–404.
- Zaslavsky, A. M., Zaborski, L., & Cleary, P. D. (2000). Does the effect of respondent characteristics on consumer assessments vary across health plans? Medical Care Research and Review, 57(3), 379–394.
- Zimmerman, J. E., Wagner, D. P., Draper, E. A., Wright, L., Alzola, C., & Knaus, W.A. (1998). Evaluation of acute physiology and chronic health evaluation III predictions of hospital mortality in an independent database. Critical Care Medicine, 26(8), 1317–1326.
- An Examination of Methods for Risk-Adjustment of Rehospitalization Rates
Mental Health Services Research
Volume 3, Issue 1 , pp 15-24
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers-Plenum Publishers
- Additional Links
- mental health
- Author Affiliations
- 1. Washington Institute for Mental Illness Research and Training, Washington State University, Washington
- 2. Oklahoma Department of Mental Health and, Substance Abuse Services, Oklahoma City, Oklahoma