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Quality Measures and Sociodemographic Risk Factors: The Rural Context

Henning-Smith, C., Kozhimannil, K.B., Prasad, S., Casey, M.M., Moscovice, I.S.

Researchers and policymakers have publicly discussed and debated whether or not to adjust provider quality measures for differences in patient characteristics. Lacking in this discussion, however, is a nuanced understanding of how adjustment should be conducted within a rural context and what impact it might have on patients and providers when quality measures are used for benchmarking and payment.

The purpose of this project was to identify how rurality and key sociodemographic variables might affect quality-of-care outcomes and to estimate the potential impact on quality measurement.

Key Findings:

  • Across both rural and urban locations, quality of care is impacted by differences in sociodemographic characteristics, including race/ ethnicity, educational status, living arrangements, Medicaid eligibility, gender, and travel time.
  • Not all quality outcomes are equally impacted by sociodemographic characteristics, which may necessitate a multifaceted approach to risk-adjustment in research and implementation of quality improvement interventions.
  • The associations between sociodemographic characteristics and quality outcomes differ by rurality, providing evidence that it is necessary and important to take geographic context into account in any decisions about risk-adjustment for quality measures.

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