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Improving Risk Adjustment of Self-Reported Mental Health Outcomes

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Abstract

Risk adjustment for mental health care is important for making meaningful comparisons of provider, program, and system performance. The purpose of this study was to compare the predictive value of three diagnosis-based risk-adjustment models for predicting self-reported mental health outcomes. Baseline and 3-month follow-up mental health assessments were obtained on 1,023 veterans in Veterans Health Administration mental health programs between 2004 and 2006. Least-squares regression models predicting mental health outcomes used the Behavior and Symptom Identification Scale-24, Veterans RAND-36, and Brief Symptom Inventory. Sequential models began with sociodemographics, added baseline self-reported mental health, and compared three psychiatric case mix schemes: two using six diagnostic categories and the other (psychiatric case mix system [PsyCMS]) using 46 categories. R 2 were lowest for sociodemographic models (0.010–0.074) and highest for models with the PsyCMS (0.187–0.425). The best predictive ability was obtained when baseline mental health and 1 year of psychiatric diagnoses were added to sociodemographic models; however, the “best” risk-adjustment model differed between inpatients and outpatients.

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Acknowledgments

This research was supported by VA grant IIR 02-290 from the VA Health Services Research and Development (HSR&D) Service. All work was done at the Center for Health Quality, Outcomes and Economic Research in Bedford, MA, USA. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. The authors express appreciation to Nicole DelVecchio for the assistance with the manuscript preparation and to the clinical programs that participated in this research.

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Authors and Affiliations

  1. Center for Health Quality, Outcomes, and Economic Research (a VA HSR&D Center of Excellence), Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road (152), Bedford, MA, 01730, USA

    Amy K. Rosen PhD, Sharmila Chatterjee MD, MPH, Mark E. Glickman PhD, Pradipta Seal MS & Susan V. Eisen PhD

  2. Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA

    Amy K. Rosen PhD, Mark E. Glickman PhD & Susan V. Eisen PhD

  3. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA

    Avron Spiro III PhD

  4. Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), Boston, MA, USA

    Avron Spiro III PhD

  5. PointRight, Lexington Office Park, 420 Bedford Street, Suite 210, Lexington, MA, USA

    Pradipta Seal MS

Authors
  1. Amy K. Rosen PhD
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  2. Sharmila Chatterjee MD, MPH
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  3. Mark E. Glickman PhD
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  4. Avron Spiro III PhD
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  5. Pradipta Seal MS
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  6. Susan V. Eisen PhD
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Corresponding author

Correspondence to Amy K. Rosen PhD.

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Rosen, A.K., Chatterjee, S., Glickman, M.E. et al. Improving Risk Adjustment of Self-Reported Mental Health Outcomes. J Behav Health Serv Res 37, 291–306 (2010). https://doi.org/10.1007/s11414-009-9196-9

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  • DOI: https://doi.org/10.1007/s11414-009-9196-9

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