This article examines whether different risk adjusters are needed for home care outcome measures for post-acute care clients. Multiple risk adjusters that met clinical and policy criteria were tested using multiple logistic regression on a sample of 4403 post-acute home care clients from Michigan. Two of the 6 outcome measures had substantially different risk adjusters for the post-acute care population versus the general population. Care should be taken to select outcome measures and risk adjusters for special home care populations.
Kosecoff J, Kahn KL, Rogers WH, et al.Prospective payment system and impairment at discharge. The "quicker-and-sicker" story revisited. JAMA. 1990;264:1980-1983.
2.
Manton KG, Woodbury MA, Vertrees JC, et al.Use of medicare services before and after introduction of the prospective payment system. Health Serv Res. 1993;3:269-292.
3.
Shriver K. Outpatient, post-acute care grows. Mod Healthc. 1996;21:86-91.
4.
Zimmerman DR, Karon SL, Arling G, et al.Development and testing of nursing home quality indicators. Health Care Financ Rev. 1995;16:107-127.
5.
Morris J, Jones R, Harris Y, et al.Pilot field data collection efforts to validate nursing home quality indicators. Baltimore, Md: Centers for Medicare and Medicaid Services. Available at: http://www.cms.gov/providers/nursinghomes/nhi/PreReport30.pdf. Accessed May 15, 2002.
6.
Hirdes JP, Fries BE, Morris JN, et al.Home care quality indicators (HCQIs) based on the MDS-HC. In press.
7.
Arling G, Karon SL, Sainfort F, et al.Risk adjustment of nursing home quality indicators. Gerontologist. 1997;37:757-766.
8.
Morris JN, Fries BE, Steel K, et al.Comprehensive clinical assessment in community setting: applicability of the MDS-HC. J Am Geriatr Soc. 1997;45:1017-1024.
9.
Hawes C, Morris JN, Phillips CD, et al.Reliability estimates for the minimum data set for nursing home resident assessment and care screening (MDS). Gerontologist. 1995;35:172-178.
10.
Sgadari A, Morris JN, Fries BE, et al.Efforts to establish the reliability of the resident assessment instrument. Age Ageing. 1997;26:27-31.
11.
Fleiss JL. Statistical Methods for Rates and Proportions. New York: John Wiley & Sons, Inc;1973.
12.
Morris JN, Fries BE, Mehr DR, et al.MDS cognitive performance scale. J Gerontol A Biol Sci Med Sci. 1994;49:M174-M182.
13.
Hartmaier SL, Sloane PD, Guess HA, et al.Validation of the minimum data set cognitive performance scale: agreement with the mini-mental state examination. J Gerontol A Biol Sci Med Sci. 1995;50:M128-M133.
14.
Morris JN, Fries BE, Morris SA. Scaling ADLs within the MDS. J Gerontol A Biol Sci Med Sci. 1999;54:M546-M553.
15.
Fries BE, Simon SE, Morris JN, et al.Pain in US nursing homes: validating a pain scale for the minimum data set. Gerontologist. 2001;41:173-179.
16.
Hirdes JP, Frijters DH, Teare GF. The MDS-CHESS scale: a new measure to predict mortality in institutionalized older people. J Am Geriatr Soc. 2003;51:96-100.
17.
SAS Language for Personal Computers [computer program]. Version 8.2. Cary, NC: SAS Institute;1999.
