Epi235 epi methods in hsr
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EPI235: Epi Methods in HSR. March 31, 2005 L2 Evaluating Health Services using administrative data 1: Introduction to Risk Adjustment (Dr. Schneeweiss)

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Epi235 epi methods in hsr

EPI235: Epi Methods in HSR

March 31, 2005L2

Evaluating Health Services using administrative data 1: Introduction to Risk Adjustment (Dr. Schneeweiss)

This lecture gives an overview of the various approaches of adjusting for confounding typical to Health Services Research. The purpose and mechanics of proprietary and non-proprietary risk-adjustment tools for clinical and administrative data, including DRGs, ACGs, and comorbidity indices will be discussed.

Students will explore the value of standard tools for risk adjustment in Health Services studies.

Background reading:

Iezzoni LI: Risk and outcomes. In: Iezzoni LI (ed.): Risk adjustment for measuring healthcare outcomes. Health Administration Press, Chicago, 1997.

Schneeweiss S, Maclure M: Use of Comorbidity Scores for Control of Confounding in Studies using Administrative Databases. Int J Epidemiol 2000,29:891-898.


Epi235 epi methods in hsr

Remember: A confounder is an independent risk factor that is unbalanced between exposure groups.

(16*920)/(80*184) = 1.0

1.0

2.0

68%

10.0

90%


Epi235 epi methods in hsr

The Charlson Index:


Epi235 epi methods in hsr

The Charlson Index for claims data:


Epi235 epi methods in hsr

The Chronic Disease Score (CDS):


Epi235 epi methods in hsr

Comorbid conditions according to Elixhauser et al.


Epi235 epi methods in hsr

CDS revisited:


Epi235 epi methods in hsr

DRGs:


Epi235 epi methods in hsr

DRGs:

DRG

159

DRG

161

DRG

160

DRG

162


Epi235 epi methods in hsr

DRGs:


Epi235 epi methods in hsr

=> Prediction of future ambulatory care is easier than prediction of health outcomes:

Prior care is a very strong predictor of future care all things equal


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