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Publication type: Article in scientific journal
Type of review: Peer review (publication)
Title: Adjusting client-level risks impacts on home care organization ranking
Authors: Wagner, Aylin
Schaffert, René
Dratva, Julia
et. al: No
DOI: 10.3390/ijerph18115502
Published in: International Journal of Environmental Research and Public Health
Volume(Issue): 18
Issue: 11
Page(s): 5502
Issue Date: 21-May-2021
Publisher / Ed. Institution: MDPI
ISSN: 1660-4601
Language: English
Subjects: Spitex; Risikoadjustierung; Qualitätsmessung; Qualitätsindikator
Subject (DDC): 362: Health and social services
Abstract: Quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) offer the opportunity to assess home care quality and compare home care organizations’ (HCOs) performance. For fair comparisons, providers’ QI rates must be risk-adjusted to control for different case-mix. The study’s objectives were to develop a risk adjustment model for worsening or onset of urinary incontinence (UI), measured with the RAI-HC QI bladder incontinence, using the database HomeCareData and to assess the impact of risk adjustment on quality rankings of HCOs. Risk factors of UI were identified in the scientific literature, and multivariable logistic regression was used to develop the risk adjustment model. The observed and risk-adjusted QI rates were calculated on organization level, uncertainty addressed by nonparametric bootstrapping. The differences between observed and risk-adjusted QI rates were graphically assessed with a Bland-Altman plot and the impact of risk adjustment examined by HCOs tertile ranking changes. 12,652 clients from 76 Swiss HCOs aged 18 years and older receiving home care between 1 January 2017, and 31 December 2018, were included. Eight risk factors were significantly associated with worsening or onset of UI: older age, female sex, obesity, impairment in cognition, impairment in hygiene, impairment in bathing, unsteady gait, and hospitalization. The adjustment model showed fair discrimination power and had a considerable effect on tertile ranking: 14 (20%) of 70 HCOs shifted to another tertile after risk adjustment. The study showed the importance of risk adjustment for fair comparisons of the quality of UI care between HCOs in Switzerland.
Fulltext version: Published version
License (according to publishing contract): CC BY 4.0: Attribution 4.0 International
Departement: School of Health Sciences
Organisational Unit: Institute of Public Health (IPH)
Published as part of the ZHAW project: Swiss Home Care Data: Bessere Daten zur Qualität der häuslichen Pflege (Spitex)
Appears in collections:Publikationen Gesundheit

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