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Health Serv Res. 2008 Dec;43(6):2014-32. doi: 10.1111/j.1475-6773.2008.00894.x. Epub 2008 Sep 8.

Case-mix adjustment of consumer reports about managed behavioral health care and health plans.

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  • 1Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA.

Abstract

OBJECTIVE:

To develop a model for adjusting patients' reports of behavioral health care experiences on the Experience of Care and Health Outcomes (ECHO) survey to allow for fair comparisons across health plans.

DATA SOURCE:

Survey responses from 4,068 individuals enrolled in 21 managed behavioral health plans who received behavioral health care within the previous year (response rate = 48 percent).

STUDY DESIGN:

Potential case-mix adjustors were evaluated by combining information about their predictive power and the amount of within- and between-plan variability. Changes in plan scores and rankings due to case-mix adjustment were quantified.

PRINCIPAL FINDINGS:

The final case-mix adjustment model included self-reported mental health status, self-reported general health status, alcohol/drug treatment, age, education, and race/ethnicity. The impact of adjustment on plan report scores was modest, but large enough to change some plan rankings.

CONCLUSIONS:

Adjusting plan report scores on the ECHO survey for differences in patient characteristics had modest effects, but still may be important to maintain the credibility of patient reports as a quality metric. Differences between those with self-reported fair/poor health compared with those in excellent/very good health varied by plan, suggesting quality differences associated with health status and underscoring the importance of collecting quality information.

PMID:
18783456
[PubMed - indexed for MEDLINE]
PMCID:
PMC2613989
Free PMC Article
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