Validity of the risk adjustment approach to compare outcomes
This paper focuses on the issue of the extent to which the present mainstream risk adjustment (RA) methodology for measuring outcomes is a valid and useful tool for quality-improvement activities. The method's predictive and attributional validity are discussed, considering the confounding and...
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| Format: | Article |
| Language: | English |
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Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz
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| Series: | Cadernos de Saúde Pública |
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| Online Access: | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0102-311X2003000100032&lng=en&tlng=en |
| _version_ | 1818330557351723008 |
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| author | Leticia Krauss Silva |
| author_facet | Leticia Krauss Silva |
| author_sort | Leticia Krauss Silva |
| collection | DOAJ |
| description | This paper focuses on the issue of the extent to which the present mainstream risk adjustment (RA) methodology for measuring outcomes is a valid and useful tool for quality-improvement activities. The method's predictive and attributional validity are discussed, considering the confounding and effect modification produced by medical care over risk variables' effect. For this purpose, the sufficient-cause model and the counterfactual approach to effect and interaction are tentatively applied to the relationships between risk (prognostic) variables, medical technology, and quality of care. The main conclusions are that quality of care modifies the antagonistic interaction between medical technologies and risk variables, related to different types of responders, as well as the confounding of the effect of risk variables produced by related medical technologies. Thus, confounding of risk factors in the RA method, which limits the latter's predictive validity, is related to the efficacy and complexity of associated medical technologies and to the quality mix of services. Attributional validity depends on the validity of the probabilities estimated for each subgroup of risk (predictive validity) and the percentage of higher-risk patients at each service. |
| first_indexed | 2024-12-13T13:05:51Z |
| format | Article |
| id | doaj.art-cddfb904ea134b9a9e6d010e162e9444 |
| institution | Directory Open Access Journal |
| issn | 0102-311X 1678-4464 |
| language | English |
| last_indexed | 2024-12-13T13:05:51Z |
| publisher | Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz |
| record_format | Article |
| series | Cadernos de Saúde Pública |
| spelling | doaj.art-cddfb904ea134b9a9e6d010e162e94442022-12-21T23:44:50ZengEscola Nacional de Saúde Pública, Fundação Oswaldo CruzCadernos de Saúde Pública0102-311X1678-4464191287295S0102-311X2003000100032Validity of the risk adjustment approach to compare outcomesLeticia Krauss Silva0Fundação Oswaldo CruzThis paper focuses on the issue of the extent to which the present mainstream risk adjustment (RA) methodology for measuring outcomes is a valid and useful tool for quality-improvement activities. The method's predictive and attributional validity are discussed, considering the confounding and effect modification produced by medical care over risk variables' effect. For this purpose, the sufficient-cause model and the counterfactual approach to effect and interaction are tentatively applied to the relationships between risk (prognostic) variables, medical technology, and quality of care. The main conclusions are that quality of care modifies the antagonistic interaction between medical technologies and risk variables, related to different types of responders, as well as the confounding of the effect of risk variables produced by related medical technologies. Thus, confounding of risk factors in the RA method, which limits the latter's predictive validity, is related to the efficacy and complexity of associated medical technologies and to the quality mix of services. Attributional validity depends on the validity of the probabilities estimated for each subgroup of risk (predictive validity) and the percentage of higher-risk patients at each service.http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0102-311X2003000100032&lng=en&tlng=enrisk adjustmentoutcomesvalidity |
| spellingShingle | Leticia Krauss Silva Validity of the risk adjustment approach to compare outcomes Cadernos de Saúde Pública risk adjustment outcomes validity |
| title | Validity of the risk adjustment approach to compare outcomes |
| title_full | Validity of the risk adjustment approach to compare outcomes |
| title_fullStr | Validity of the risk adjustment approach to compare outcomes |
| title_full_unstemmed | Validity of the risk adjustment approach to compare outcomes |
| title_short | Validity of the risk adjustment approach to compare outcomes |
| title_sort | validity of the risk adjustment approach to compare outcomes |
| topic | risk adjustment outcomes validity |
| url | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0102-311X2003000100032&lng=en&tlng=en |
| work_keys_str_mv | AT leticiakrausssilva validityoftheriskadjustmentapproachtocompareoutcomes |