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Correlation of Risk Adjustment Measures Based on Diagnoses and Patient Self-Reported Health Status
Wang M, Rosen A, Kazis L, Loveland S, Berlowitz D. Correlation of Risk Adjustment Measures Based on Diagnoses and Patient Self-Reported Health Status. Health Services and Outcomes Research Methodology. 2001 Feb 12; 1(3-4):351-365.
Case-mix adjustments have traditionally used diagnosis-based models such as Diagnostic Cost Groups (DCGs). The recent development availability of reliabile and valid patient self-reported health status measures such as the Veterans SF-36 (Short Form Health Survey) may be useful in complementing existing diagnostic information in describing patients' health status for purposes of risk adjustment. However, the correlation between these two approaches has not been explored. We collected SF-36 data from 31,419 veterans nationwide based on a national probability sample of veterans receiving ambulatory care to asess the physical (PCS) and mental (MCS) component of patient self-reported health status. In addition, we used inpatient and outpatient diagnoses from one year (1/1/97 to 1/1/98) to calculate DCG relative risk scores, with the 1991 Medicare beneficiary population as the benchmark. We found that higher DCG relative risk scores were associated with worse PCS (r = -.0.223, p < 0.05) and MCS (r = - 0.174, p < 0.05) scores. Further examination of the distribution of MCS categories (MCS < 40) across the five psychiatric hierarchical condition categories (HCCs) in the DCG/HCC model showed a small association between MCS category and disease severity level. These results suggest that risk adjustment approaches based on patient self-reported health status and diagnoses convey different case-mix information, specifically for patients with psychiatric conditions. These two approaches can be used as the basis for the development of a more comprehensive risk adjustment model which incorporates both the providers' and the patients' perspectives in predicting resource utilization.