Statement of the Problem: There has been significant discussion lately among researchers and policy‐makers about whether or not to adjust provider quality measures for differences in patient characteristics. Lacking in this discussion, however, is an understanding of how adjustment should be done within a rural context and what impact it might have on patients and providers.

Project Goals: The purpose of this project is:

For three acute care conditions/diagnoses (potential examples include diabetes, congestive heart failure, COPD)

• Identify the key socio-demographic variables that may affect quality adjustment for rural populations/providers
• Identify data sources/strategies available for the above variables
• Identify the quality measures (e.g. readmission rates) that should be adjusted for socio-demographic variables for rural populations/providers and estimate the potential impact of those adjustments on quality measurement

Methods: We will use a literature review and an expert panel to identify key socio-demographic variables that may affect quality adjustment for rural populations and providers. Available secondary data sources will be used to estimate the potential impact of socio-demographic adjustment on relevant quality measures.

Publications

• Quality Measures and Sociodemographic Risk Factors: The Rural Context
  Policy Brief
  University of Minnesota Rural Health Research Center
  Date: 05/2016
  This policy brief aims to inform discussions concerning whether or not to adjust provider quality measures for differences in patient characteristics by examining how rurality and key sociodemographic variables might affect quality-of-care outcomes.
• Rural-Urban Differences in Medicare Quality Outcomes and the Impact of Risk Adjustment
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 09/2017
  This study examined the differences in quality of care outcomes between rural and urban Medicare beneficiaries. It concluded that rurality should be considered when discussing risk-adjustment procedures.
• Rural-Urban Differences in Medicare Quality Scores Persist After Adjusting for Sociodemographic and Environmental Characteristics
  Journal Article
  University of Minnesota Rural Health Research Center
  Date: 09/2017
  Patient sociodemographic characteristics, such as age, race, gender, income, and education, can affect health outcomes and healthcare providers' performance on quality measures. The discussion about how to tackle these issues around quality measurement haven't included rurality, but this study examines it.