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NQF Proposes Sociodemographic Risk Adjustment to Address Care Disparities

The National Quality Forum (NQF) recently released a draft report called Risk Adjustment for Socioeconomic Status or Other Sociodemographic Factors. The report covers whether performance measures used in accountability applications, such as pay-for-performance or public reporting, should be adjusted for socioeconomic factors when determining results.

With funding from the U.S. Department of Health and Human Services, NQF convened an expert panel to identify and examine issues related to risk adjusting outcome performance measures for sociodemographic factors.

The panel focused its work on the effects of current NQF policy, which does not allow for sociodemographic adjustments, and its impact on disadvantaged populations. The current prohibition stems from a desire to make disparities visible to encourage care improvements for disadvantaged patients. However, the panel raised concerns that this policy could worsen access to care for vulnerable patients and shift funding (through the use of performance-based incentives) away from providers that predominately serve the disadvantaged.

With those considerations in mind, the panel concluded that the current policy unintentionally weakens the provider networks upon which disadvantaged populations rely and might, in fact, worsen care disparities.

In response, the panel offered recommendations to help providers both reduce care disparities and accurately capture the quality of care provided.

The eight draft recommendations include the following:

  • Include sociodemographic factors when risk adjusting the performance score of outcome and process of care measures used in accountability applications, such as public reporting and pay-for-performance.
  • Stratify performance measures according to sociodemographic factors to identify and reduce disparities.
  • Make explicit NQF’s existing policy that performance measures are endorsed for specific contexts, i.e., for a specific patient population, data source, care setting, and level of analysis.

To read all eight recommendations, view the draft report or read our special update.

The panel noted a lack of high-quality and readily available sociodemographic data as a major barrier to full implementation of its recommendations. Without these types of data,  policymakers are challenged to analyze the effect of sociodemographic factors on health outcomes and performance measurement to adequately and accurately inform payment policy.

Members are encouraged to submit comments on the draft recommendations directly to NQF by April 16.

Please contact Xiaoyi Huang, director of policy, at or 202.585.0127 with questions.


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Please contact Xiaoyi Huang, director of policy, at or 202.585.0127 with questions.

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