Abstract:
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While adjustment of quality measures based on outcomes for patient clinical characteristics is generally accepted, both adjustment of process measures and adjustment for social characteristics remain controversial, all the more so in combination. Arguments for adjustment emphasis unfairness and perverse incentives potentially affecting poor-serving institutions while opponents rejoin that adjustment would excuse poor quality of services to disadvantaged patients. Recent consideration of this issue by committees of the National Quality Forum and Institute of Medicine has advanced this debate. We will discuss this controversy from policy, scientific, and ethical perspectives.
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