Robst John, Cogburn Ryan, Forlines Grayson, Frazier Lex, Kautter John
RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709-2194, USA.
Health Aff Sch. 2024 Nov 27;2(12):qxae161. doi: 10.1093/haschl/qxae161. eCollection 2024 Dec.
There is strong interest among policymakers to adjust for area-level deprivation when making payments to providers because such areas have traditionally been underserved. The Medicare Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model provides higher payments to ACOs serving areas with greater deprivation. Area Deprivation Index (ADI) is the primary component to measure deprivation for ACO REACH. The ADI is a commonly used deprivation index, but there are concerns about its methodology, primarily its use of nonstandardized deprivation factors. Prior research indicates the ADI is mainly determined by home values, which does not allow it to adequately capture deprivation in urban areas. This paper revises and updates the ADI, using American Community Survey data to compute a census block group deprivation index, the Community Deprivation Index (CDI). The CDI standardizes the deprivation factors to be unit neutral, applies statistical shrinkage to account for the imprecise measurement of the factors, updates several factors, and reweights the factors using the most recently available data. Validation tests suggest the CDI exhibits higher correlations with several health outcome/utilization measures than the ADI. The CDI will better serve policymakers by improving identification of urban areas with higher deprivation.
政策制定者在向医疗服务提供者付款时，对考虑地区层面的贫困状况进行调整有着浓厚兴趣，因为这些地区传统上一直缺乏足够的服务。医疗保险责任医疗组织实现公平、可及性和社区健康（ACO REACH）模式向服务于贫困程度更高地区的责任医疗组织提供更高的支付。地区贫困指数（ADI）是衡量ACO REACH贫困程度的主要组成部分。ADI是一种常用的贫困指数，但人们对其方法存在担忧，主要是其使用的非标准化贫困因素。先前的研究表明，ADI主要由房屋价值决定，这使得它无法充分反映城市地区的贫困状况。本文对ADI进行了修订和更新，利用美国社区调查数据计算了普查街区组贫困指数，即社区贫困指数（CDI）。CDI将贫困因素标准化为单位中立，应用统计收缩来考虑因素测量的不精确性，更新了几个因素，并使用最新可得数据对因素进行重新加权。验证测试表明，与ADI相比，CDI与几种健康结果/利用指标的相关性更高。CDI将通过更好地识别贫困程度更高的城市地区，为政策制定者提供更好的服务。
