The Risks of Not Adjusting Performance Measures for Sociodemographic Factors

Abstract

The National Quality Forum (NQF) recently convenedan expert panel to make recommendations on a much-debated topic: whether to risk-adjust health care outcomes for sociodemographic factors present at the initiation of medical care and treatment. The panel completed its work in early July 2014, making the following recommendation: When there is a conceptual relationship (i.e., logical rationale or theory) between sociodemographic factors and outcomes or processes of care and empirical evi-dence (e.g., statistical analysis) that sociodemographic factors affect an outcome or process of care reflected in a performance measure: those sociodemographic factors should be included in risk adjustment of the perfor-mance score (using accepted guidelines for selecting risk factors) unless there are conceptual reasons or em-pirical evidence indicating that adjustment is unneces-