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NQF Releases Final Report on Risk-Adjustment Trial

The National Quality Forum (NQF) has released a final report evaluating its two-year trial period that allowed for consideration of social risk factors as part of the measure endorsement process.

Before the trial period, NQF barred the use of social risk factors in risk-adjustment models of NQF-endorsed measures. Between April 2015 and April 2017, for any measure submitted for endorsement, the NQF Consensus Development Process standing committees could consider if the measure properly accounted for social risk.

Of the 303 performance measures submitted during the trial period, 65 were determined to have a conceptual basis for adjustment for social risk factors. Seventeen of those also were found to have empirical evidence to support adjustment and were endorsed or recommended for endorsement.

In its evaluation of the trial period, NQF found that measures with a conceptual basis for risk adjustment did not always demonstrate an empirical relationship. The report notes that important considerations and challenges — such as availability of data on social risk — were revealed during the trial period.

Based on the evaluation of the trial period, NQF on July 20 recommended to its board the option of launching a new three-year initiative. The new initiative would ensure NQF continues to drive progress on this issue by exploring outstanding questions about approaches to adjustment for social risk factors. NQF said the initiative also would be responsive to concerns raised by America’s Essential Hospitals and other hospital associations in a March 2017 joint letter to the board.

Contact Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Maryellen Guinan is a principal policy analyst at America's Essential Hospitals.

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