Abstract
Palsbo SE, Diao G, Palsbo GA, Tang L, Rosenberger WF, Mastal MF. Case-mix adjustment
and enabled reporting of the health care experiences of adults with disabilities.
Objectives
To develop activity limitation clusters for case-mix adjustment of health care ratings
and as a population profiler, and to develop a cognitively accessible report of statistically
reliable quality and access measures comparing the health care experiences of adults
with and without disabilities, within and across health delivery organizations.
Design
Observational study.
Setting
Three California Medicaid health care organizations.
Participants
Adults (N = 1086) of working age enrolled for at least 1 year in Medicaid because
of disability.
Interventions
Not applicable.
Main Outcome Measures
Principal components analysis created 4 clusters of activity limitations that we used
to characterize case mix. We indentified and calculated 28 quality measures using
responses from a proposed enabled version of the Consumer Assessment of Healthcare
Providers and Systems (CAHPS) survey. We calculated scores for overall care as the
weighted mean of the case-mix adjusted ratings.
Results
Disability caused a greater bias on health plan ratings and specialist ratings than
did demographic factors. Proxy respondents rated care the same as self-respondents.
Telephone and mail administration were equivalent for service reports, but telephone
respondents tended to offer more positive global ratings. Plan-level reliability estimates
for new composites on shared decision making and advice on healthy living are .79
and .87, respectively. Plan-level reliability estimates for a new composite measure
on family planning did not discriminate between health plans because respondents rated
all health plans poorly. Approximately 125 respondents per site are necessary to detect
group differences.
Conclusions
Self-reported activity limitations incorporating standard questions from the American
Community Survey can be used to create a disability case-mix index and to construct
profiles of a population's activity limitations. The enabled comparative report, which
we call the Assessment of Health Plans and Providers by People with Activity Limitations,
is more cognitively accessible than typical CAHPS report templates for state Medicaid
plans. The CAHPS Medicaid reporting tools may provide misleading ratings of health
plan and physician quality by people with disabilities because the mean ratings do
not account for systematic biases associated with disability. More testing on larger
populations would help to quantify the strength of various reporting biases.
Key Words
List of Abbreviations:
CAHPS (Consumer Assessment of Healthcare Providers and Systems), HCBS (home and community–based services), HMO (health maintenance organization)To read this article in full you will need to make a payment
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Article info
Footnotes
Supported by the National Institutes for Disability Rehabilitation and Research (grant no. H133A040016), the California HealthCare Foundation (grant no. 221417), and the Center for Health Care Strategies (grant no. 99906).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
This article reflects only the authors' opinions and does not necessarily reflect the official positions of the funders or the author's institutions. At the time of submission, the Agency for Healthcare Research and Quality has not adopted the enabled CAHPS or the AHPPPAL report template.
Reprints are not available from the author.
Identification
Copyright
© 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
