Study: Adjusting for social risk factors in performance measures feasible

Social risk adjustments could help even the playing field for measuring quality care if chosen carefully, according to an NQF study.

A two-year study assessing the potential for adjusting performance quality measures for social risk factors found the practice feasible but difficult.

The National Quality Forum (NQF) self-funded and conducted the study of 303 total candidate measures for social risk adjustment between 2015 and 2017. In the end, the group endorsed 17 of the 65 measures it deemed to have a “conceptual basis” for social risk adjustment.

The link between social risk factors and population health has driven interest in the way collecting and analyzing data around social and demographic factors could be put to use improving care. For example, recent studies have linked racial disparity with readmission rates, suggesting certain hospitals have been needlessly penalized for a quality metric that may not even improve mortality rates in the first place.

While pointing out that adjusting for social risk factors has potential for addressing issues such as the unnecessary penalization of safety-net hospitals, the NQF also acknowledges that the practice has been controversial, in part because the effects do not always live up to expectations. The report notes that the conceptual and empirical effect social risk factors had on outcomes varied widely in the study. This suggests a need for caution and close study to ensure adjustments drive changes that actually move the needle in terms of improving quality of care.

“Every stakeholder wants to see the quality of care for all Americans, especially the most vulnerable, improve while ensuring a level playing field for providers in value-based purchasing programs,” noted NQF’s president and CEO, Shantanu Agrawal, M.D., in an announcement accompanying the report’s release. “The frequent use of NQF-endorsed measures for payment purposes underscores the importance of ensuring accurate comparisons of providers so that rewards or penalties are fairly assessed and based on true differences in performance.”

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