Journal article

Use of past care markers in risk-adjustment: accounting for systematic differences across providers

Laura Anselmi, Yiu-Shing Lau, Matt Sutton, Anna Everton, Rob Shaw, Stephen Lorrimer



Risk-adjustment models are used to predict the cost of care for patients based on their observable characteristics, and to derive efficient and equitable budgets based on weighted capitation. Markers based on past care contacts can improve model fit, but their coefficients may be affected by provider variations in diagnostic, treatment and reporting quality. This is problematic when distinguishing need and supply influences on costs is required.We examine the extent of this bias in the national formula for mental health care using administrative records for 43.7 million adults registered with 7746 GP practices in England in 2015. We also illustrate a method to control for provider effects.A ..

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Awarded by UK Research Initiative -Medical Research Council (UKRI MRC)

Awarded by NIHR

Funding Acknowledgements

Laura Anselmi was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester and from the UK Research Initiative -Medical Research Council (UKRI MRC) grant MR/S022554/1. Yiu-Shing Lau is funded by the NIHR Policy Research Programme reference: PR-PRU-1217-20801. Matt Sutton is an NIHR Senior Investigator. Anna Everton, Rob Shaw and Stephen Lorrimer were funded by NHS England and Improvement at the time of the study. The views expressed are those of the author(s) and not necessarily those of the National Institute of Health Research (NIHR), National Health Service, Greater Manchester or the Department of Health and Social Care, nor of the UKRI MRC.