Additional technical information about facility-level risk adjustment.

September 20, 2009 by admin

The following information is provided for individuals who are seeking a more indepth understanding of how facility-level risk adjustment is applied to the pressure ulcer, delirium, and walking as well or better quality measures that are presented on Nursing Home Compare. Facility-level risk adjustment is also commonly referred to as facility admission profile (FAP) risk adjustment. Facility-level Risk Adjustment (for the Pressure Ulcer Quality Measure: The use of the facility admission profile (FAP) is to take into account the type of residents typically admitted to the nursing home over the past year. For example, for pressure sores, if a nursing home admits a lot of residents with stage 3 or stage 4 pressure ulcers, they may not be able to heal all of these pressure sores by the time a quarterly MDS assessment is performed. Therefore, the nursing home will look like they have a higher rate of pressure sores than a nursing home that "cherry picks" or avoids residents with pressure sores. For this reason, the FAP gives "credit" to nursing homes that admit more residents with pressure sores by lowering their reported quality measure rate (i.e. making them look better). Facility-level Risk Adjustment for the Delirium Quality Measure: In the case of delirium, a nursing home that admits a lot of residents with delirium may not be able to resolve their symptoms of delirium by the time the 14 day MDS assessment is completed. Therefore, if the nursing home admits a lot of residents with delirium, they would look worse than a nursing home that avoids residents with delirium. Therefore, we give "credit" to nursing homes that admit a higher percent of residents with delirium and their reported rate is lower (looks better) than it would without the FAP. Facility-level Risk Adjustment for the Walking as Well or Better Quality Measure: In the case of this measure, we give credit to nursing homes that admit a lot of residents who cannot walk upon admission because it may be harder to get these residents ambulating by day 14 than it would be to improve walking performance in residents who are already ambulating with or without assistance. Additional information about how the data for the quality measures is compiled and calculated can be viewed on the Nursing Home Quality Intiative page on www.cms.hhs.gov.