How Well Does the CDPS Predict Utilization: A Comparison to Other Case-mix Measures

Rosen A. How Well Does the CDPS Predict Utilization: A Comparison to Other Case-mix Measures. Paper presented at: VA HSR&D National Meeting; 2002 Feb 14; Washington, DC.

Related HSR&D Project(s)

• IIR 20-035 – Development and Application of Psychiatric Risk Adjustment Methods in the VA

BACKGROUND / RATIONAL: Risk adjustment is essential for understanding resource utilization, provider profiling, resource allocation, and quality. Performance monitoring efforts in the VA have been hindered by the lack of an adequate risk adjustment method for patients with mental health and/or substance abuse (MH/SA) disorders. The number of veterans receiving VA mental health services has increased 36% in the last decade, totaling over 650,000 veterans in FY'99 at a cost of almost $2 billion. Budget restrictions and staffing limitations have heightened the need for accurate methods for profiling services, assessing quality, and allocating resources, but these efforts have been limited by lack of an adequate MH/SA case-mix measure. Whereas most prior psychiatric case-mix research has focused on outcomes in inpatient settings or variations of particular MH/SA disorders, VA mental health services has undergone a major shift from inpatient to outpatient care. OBJECTIVE (S):Our principal objectives are to: 1) derive and validate a risk adjustment methodology for veterans with MH/SA disorders using psychiatric diagnosis-based patient groupings piloted by one of our team members; 2) to compare the predictive power of this method and existing models to explain concurrent (FY'98) and prospective (FY'98 to FY'99) MH/SA and total utilization and costs among patients with psychiatric diagnoses; and 3) to profile variation in MH/SA utilization and expenditures across VA facilities nationally. METHODS:The two main sources of data for this project are VA and Medicare files. At the VA, we will access four databases via the Austin Automation Center: the Outpatient Clinic File, the Patient Treatment File, the Extended Care File, and the Beneficiary Identification and Record Locator Subsystem File. We will also obtain utilization cost estimates from the VA Health Economics Research Center, and total pharmacy costs from the VA Allocation Resource Center. From Medicare, we will obtain denominator, inpatient, outpatient, and provider files from the same time period, which will be merged with VA files using patients' social security numbers. The Area Resource File and the American Psychological Association data will be used for information on provider density. FINDINGS / RESULTS:Merging and cleaning up of data is nearly completed and the MH/SA cohort data for FY'99 and FY'00 has been downloaded. We tested the MH/SA cohort data for FY'99 on the ACG, DCG, and CDPS systems and have begun to run descriptive statistics on the psychiatric grouping diagnostic system. STATUS:Project work is ongoing.IMPACT:This project is of great relevance to the VA. We plan to derive a diagnosis-based, psychiatric case-mix measure, specific to the VA, that can be used to profile and predict concurrent and future resource consumption among patients with mental health and substance abuse disorders across VA facilities.PUBLICATIONS: None in FY 2002