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Editorial
April 2016

To Risk Adjust or Not to Risk AdjustShould That Be the Question?

Author Affiliations
  • 1Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
  • 2Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
JAMA Pediatr. 2016;170(4):319-320. doi:10.1001/jamapediatrics.2015.4527

Numerous studies document that social determinants of health (SDH) influence children’s health as well as their access, use, and quality of health care. Some factors seem intrinsically rooted in the child’s family background, such as parental education and family income. Other factors are more clearly extrinsic, stemming from environmental exposures (eg, lead exposure) or neighborhood issues (eg, street crime).

As Sills and colleagues1 point out in this issue of JAMA Pediatrics, there has been a longstanding debate about the degree to which performance assessment programs such as pay-for-performance and public reporting should take SDH into account.2 Those in favor of “controlling” for SDH argue that the adjustment prevents unfair penalties from being applied to hospitals or clinicians who disproportionately care for vulnerable patients. Those against it argue that adjusting performance measures for SDH excuses hospitals and clinicians for poor performance delivered to vulnerable patients.

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