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In 2006, the National Quality Forum (NQF) established a policy against adjusting quality measures for sociodemographic risk factors, ie, socioeconomic status and other social risk factors.1 This policy was based on concern that statistical adjustment could mask poor care provided to socially disadvantaged patients and create lower standards of care. However, given the potential influence of sociodemographic risk on health and health care, this policy of not including risk adjustment, adopted by the Centers for Medicare & Medicaid Services (CMS) and others, potentially results in unfair comparisons among clinicians, hospitals, and other health care organizations.2
Fiscella K, Burstin HR, Nerenz DR. Quality Measures and Sociodemographic Risk FactorsTo Adjust or Not to Adjust. JAMA. 2014;312(24):2615-2616. doi:10.1001/jama.2014.15372