The Influence of Risk Adjustment Methods on Conclusions About Quality of Care in Nursing Homes Based on Outcome Measures

This study compares quality rankings of about 550 nursing homes in New York State, based on several outcome measures and differing risk adjustment methods. The outcomes were decline in functional status, worsening decubiti, and prevalence of physical restraints. Measures were constructed from PRI data, which are similar to MDS data. We found substantial disagreement on quality ranking across measures due to differences in the scope of risk adjustment. Insufficient risk adjustment of outcome measures may, therefore, lead to inappropriate classification of nursing homes as either poor-quality or high-quality homes. This has implications for state quality oversight, providers' reputations and patients' choice.