Department of Health Services, University of California, Los Angeles, PO Box 951772, 650 Charles E. Young Drive South, Los Angeles, CA 90095, USA.
Health Serv Res. 2010 Jun;45(3):670-90. doi: 10.1111/j.1475-6773.2010.01101.x. Epub 2010 Mar 10.
To assess the effect of case-mix adjustment on community health center (CHC) performance on patient experience measures.
A Medicaid-managed care plan in Washington State collected patient survey data from 33 CHCs over three fiscal quarters during 2007-2008. The survey included three composite patient experience measures (6-month reports) and two overall ratings of care. The analytic sample includes 2,247 adult patients and 2,859 adults reporting for child patients.
We compared the relative importance of patient case-mix adjusters by calculating each adjuster's predictive power and variability across CHCs. We then evaluated the impact of case-mix adjustment on the relative ranking of CHCs.
Important case-mix adjusters included adult self-reported health status or parent-reported child health status, adult age, and educational attainment. The effects of case-mix adjustment on patient reports and ratings were different in the adult and child samples. Adjusting for race/ethnicity and language had a greater impact on parent reports than adult reports, but it impacted ratings similarly across the samples. The impact of adjustment on composites and ratings was modest, but it affected the relative ranking of CHCs.
To ensure equitable comparison of CHC performance on patient experience measures, reports and ratings should be adjusted for adult self-reported health status or parent-reported child health status, adult age, education, race/ethnicity, and survey language. Because of the differential impact of case-mix adjusters for child and adult surveys, initiatives should consider measuring and reporting adult and child scores separately.
评估病例组合调整对社区卫生中心（CHC）在患者体验测量方面表现的影响。
华盛顿州的一项医疗补助管理式医疗计划在 2007-2008 年的三个财政季度中从 33 个 CHC 收集了患者调查数据。该调查包括三个综合患者体验测量指标（6 个月报告）和两个总体护理评级。分析样本包括 2247 名成年患者和 2859 名报告儿童患者的成年人。
我们通过计算每个调整器在 CHC 之间的预测能力和可变性，比较了患者病例组合调整器的相对重要性。然后，我们评估了病例组合调整对 CHC 相对排名的影响。
重要的病例组合调整器包括成年患者自我报告的健康状况或父母报告的儿童健康状况、成年患者年龄和教育程度。病例组合调整对成年患者和儿童患者报告和评级的影响不同。调整种族/族裔和语言对父母报告的影响大于对成年报告的影响，但对两个样本的评级影响相似。调整对综合指标和评级的影响适中，但影响了 CHC 的相对排名。
为确保公平比较 CHC 在患者体验测量方面的表现，报告和评级应根据成年患者自我报告的健康状况或父母报告的儿童健康状况、成年患者年龄、教育程度、种族/族裔和调查语言进行调整。由于病例组合调整器对儿童和成年调查的影响不同，各项倡议应考虑分别测量和报告成年和儿童的分数。
