The National Quality Forum (NQF) June 8 released a draft report evaluating their two year sociodemographic status (SDS) trial period, which concluded in April 2017. Under the trial, a prohibition on including social risk factors in the risk adjustment models of NQF-endorsed measures was lifted and certain measures could be adjusted to account for patient economic and demographic factors. The AAMC and other stakeholders have emphasized concerns that SDS factors impact a provider’s ability to influence patient outcomes, including readmissions and cost.
As noted in the report, approximately 300 measures were reviewed during the two-year trial, of which 17 were endorsed with an SDS adjustment. While a number of measures used in the Medicare hospital reporting and performance programs were reviewed, none were adjusted to account for social risk in the risk adjustment methodology.
The report cited a number of key findings and challenges from the trial period, including the following:
- Overall lack of patient-level data in which to adjust measures;
- Use of race and ethnicity as a proxy for SDS, despite previous recommendations not to do so;
- Variability among measure developers concerning which social risk factors to test;
- Variability in defining the conceptual basis for SDS adjustment; and
- Limited implementation of measures adjusted for social risk.
The Disparities Standing Committee, which has been tasked with evaluating the totality of the trial period, met in June to discuss these challenges and next steps.The NQF Board of Directors is expected to make a decision on future inclusion of SDS factors in quality measurement in July 2017.