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Article

Adjusting Client-Level Risks Impacts on Home Care Organization Ranking

1
Institute of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401 Winterthur, Switzerland
2
Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Lucerne, Switzerland
3
Medical Faculty, University of Basel, Klingelbergstrasse 61, 4056 Basel, Switzerland
*
Author to whom correspondence should be addressed.
Academic Editors: Belchin Kostov, Luis González-de Paz and Antoni Sisó-Almirall
Int. J. Environ. Res. Public Health 2021, 18(11), 5502; https://doi.org/10.3390/ijerph18115502
Received: 15 April 2021 / Revised: 16 May 2021 / Accepted: 17 May 2021 / Published: 21 May 2021
(This article belongs to the Special Issue Primary Healthcare)
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. View Full-Text
Keywords: risk adjustment; quality indicators; home care; quality of health care; urinary incontinence risk adjustment; quality indicators; home care; quality of health care; urinary incontinence
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MDPI and ACS Style

Wagner, A.; Schaffert, R.; Dratva, J. Adjusting Client-Level Risks Impacts on Home Care Organization Ranking. Int. J. Environ. Res. Public Health 2021, 18, 5502. https://doi.org/10.3390/ijerph18115502

AMA Style

Wagner A, Schaffert R, Dratva J. Adjusting Client-Level Risks Impacts on Home Care Organization Ranking. International Journal of Environmental Research and Public Health. 2021; 18(11):5502. https://doi.org/10.3390/ijerph18115502

Chicago/Turabian Style

Wagner, Aylin, René Schaffert, and Julia Dratva. 2021. "Adjusting Client-Level Risks Impacts on Home Care Organization Ranking" International Journal of Environmental Research and Public Health 18, no. 11: 5502. https://doi.org/10.3390/ijerph18115502

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