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The performance of administrative and self-reported measures for risk adjustment of Veterans Affairs expenditures.

Publication ,  Journal Article
Maciejewski, ML; Liu, C-F; Derleth, A; McDonell, M; Anderson, S; Fihn, SD
Published in: Health Serv Res
June 2005

OBJECTIVE: To evaluate the performance of different prospective risk adjustment models of outpatient, inpatient, and total expenditures of veterans who regularly use Veterans Affairs (VA) primary care. DATA SOURCES: We utilized administrative, survey and expenditure data on 14,449 VA patients enrolled in a randomized trial that gave providers regular patient health assessments. STUDY DESIGN: This cohort study compared five administrative data-based, two self-report risk adjusters, and base year expenditures in prospective models. DATA EXTRACTION METHODS: VA outpatient care and nonacute inpatient care expenditures were based on unit expenditures and utilization, while VA expenditures for acute inpatient care were calculated from a Medicare-based inpatient cost function. Risk adjusters for this sample were constructed from diagnosis, medication and self-report data collected during a clinical trial. Model performance was compared using adjusted R2 and predictive ratios. PRINCIPAL FINDINGS: In all expenditure models, administrative-based measures performed better than self-reported measures, which performed better than age and gender. The Diagnosis Cost Groups (DCG) model explained total expenditure variation (R2=7.2 percent) better than other models. Prior outpatient expenditures predicted outpatient expenditures best by far (R2=42 percent). Models with multiple measures improved overall prediction, reduced over-prediction of low expenditure quintiles, and reduced under-prediction in the highest quintile of expenditures. CONCLUSIONS: Prediction of VA total expenditures was poor because expenditure variation reflected utilization variation, but not patient severity. Base year expenditures were the best predictor of outpatient expenditures and nearly the best for total expenditures. Models that combined two or more risk adjusters predicted expenditures better than single-measure models, but are more difficult and expensive to apply.

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Published In

Health Serv Res

DOI

ISSN

0017-9124

Publication Date

June 2005

Volume

40

Issue

3

Start / End Page

887 / 904

Location

United States

Related Subject Headings

  • Utilization Review
  • United States Department of Veterans Affairs
  • United States
  • Self Disclosure
  • Risk Adjustment
  • Randomized Controlled Trials as Topic
  • Prospective Studies
  • Primary Health Care
  • Middle Aged
  • Male
 

Citation

APA
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ICMJE
MLA
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Maciejewski, M. L., Liu, C.-F., Derleth, A., McDonell, M., Anderson, S., & Fihn, S. D. (2005). The performance of administrative and self-reported measures for risk adjustment of Veterans Affairs expenditures. Health Serv Res, 40(3), 887–904. https://doi.org/10.1111/j.1475-6773.2005.00390.x
Maciejewski, Matthew L., Chuan-Fen Liu, Ann Derleth, Mary McDonell, Steve Anderson, and Stephan D. Fihn. “The performance of administrative and self-reported measures for risk adjustment of Veterans Affairs expenditures.Health Serv Res 40, no. 3 (June 2005): 887–904. https://doi.org/10.1111/j.1475-6773.2005.00390.x.
Maciejewski ML, Liu C-F, Derleth A, McDonell M, Anderson S, Fihn SD. The performance of administrative and self-reported measures for risk adjustment of Veterans Affairs expenditures. Health Serv Res. 2005 Jun;40(3):887–904.
Maciejewski, Matthew L., et al. “The performance of administrative and self-reported measures for risk adjustment of Veterans Affairs expenditures.Health Serv Res, vol. 40, no. 3, June 2005, pp. 887–904. Pubmed, doi:10.1111/j.1475-6773.2005.00390.x.
Maciejewski ML, Liu C-F, Derleth A, McDonell M, Anderson S, Fihn SD. The performance of administrative and self-reported measures for risk adjustment of Veterans Affairs expenditures. Health Serv Res. 2005 Jun;40(3):887–904.
Journal cover image

Published In

Health Serv Res

DOI

ISSN

0017-9124

Publication Date

June 2005

Volume

40

Issue

3

Start / End Page

887 / 904

Location

United States

Related Subject Headings

  • Utilization Review
  • United States Department of Veterans Affairs
  • United States
  • Self Disclosure
  • Risk Adjustment
  • Randomized Controlled Trials as Topic
  • Prospective Studies
  • Primary Health Care
  • Middle Aged
  • Male