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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 National Academy of Medicine has advanced this debate. In addition to the normative debate, this issue raises some challenges to the application of causal inference methods in consideration of health and health care disparities. We will discuss this controversy from policy, empirical, and ethical perspectives.
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