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March 25, 1998

Risk Adjustment, Quality Assessment, and Process of Care

JAMA. 1998;279(12):910-911. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-12-jbk0325

To the Editor.—In the article on risk adjustment,1 Dr Iezzoni provides valuable insights in a complex area and correctly identifies the problems that existing severity-adjustment systems exhibit. These issues most likely will persist as long as the development efforts for risk-adjustment tools remain proprietary or the application of these tools remains vulnerable to manipulation by virtue of the black-box environment they foster. Clinicians who routinely manage large patient populations must call for a public domain tool that can serve as a "metric standard." This tool must include information about an entire episode of illness along the entire continuum of care (inpatient and outpatient) and draw on both administrative and clinical information data sets such as the new electronic medical records databases can provide. The goal should be to provide clinicians and health policy analysts with comparative information that is accurate, statistically valid, and clinically relevant.