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OtherMethodology

Applying a Risk-Adjustment Framework to Primary Care: Can We Improve on Existing Measures?

Amy K. Rosen, Robert Reid, Anne-Marie Broemeling and Carter C. Rakovski
The Annals of Family Medicine May 2003, 1 (1) 44-51; DOI: https://doi.org/10.1370/afm.6
Amy K. Rosen
PhD
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Robert Reid
MD, PhD
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Anne-Marie Broemeling
PhD
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Carter C. Rakovski
MA, MS
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    Figure 1.

    Interrelationships of risk factors: relating risk to outcomes*

    * Diagnosis-based measures are based on diagnoses, demographics and resource-use outcomes. Patient self-reported approaches are based on patient self-reported information (eg, health-related quality of life) and clinical outcomes.

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    Table 1:

    Types of Clinical Case-Mix Measures

    MeasurePrimary PurposeInputsOutputsData Sources
    ACGs: Adjusted Clinical Groups. DCGs: Diagnostic Cost Groups. CDPS: Chronic Illness and Disability Payment System. HMO: Health Maintenance Organization. NDC: National Drug Codes. SF-36: Short Form Health Survey.
    Diagnosis-based ACGs, DCGs, CDPSHealth-based payment; provider profiling; quality assessment; resource allocation; disease/case managementAll diagnoses from 1 year of age; age; genderNumber of ambulatory visits per year; total expendituresMedicare; Medicaid; commercial populations (HMO claims/encounter data)
    Pharmacy-based RxRiskHealth-based payment; disease/case managementNDC codes; age; genderPharmacy costs; total costs; ambulatory visitsCommercial populations; Medicaid data
    Patient self-reported SF-36 measuresDescribe morbidityClinical dataAmbulatory visits; total expenditures; functional statusSurveys; medical records
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The Annals of Family Medicine: 1 (1)
The Annals of Family Medicine: 1 (1)
Vol. 1, Issue 1
1 May 2003
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Applying a Risk-Adjustment Framework to Primary Care: Can We Improve on Existing Measures?
Amy K. Rosen, Robert Reid, Anne-Marie Broemeling, Carter C. Rakovski
The Annals of Family Medicine May 2003, 1 (1) 44-51; DOI: 10.1370/afm.6

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Applying a Risk-Adjustment Framework to Primary Care: Can We Improve on Existing Measures?
Amy K. Rosen, Robert Reid, Anne-Marie Broemeling, Carter C. Rakovski
The Annals of Family Medicine May 2003, 1 (1) 44-51; DOI: 10.1370/afm.6
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  • Article
    • Abstract
    • INTRODUCTION
    • RISK-ADJUSTMENT FRAMEWORK FOR PRIMARY CARE
    • DIMENSIONS OF RISK IN PRIMARY CARE
    • DISCUSSION
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