# Risk-Adjusting Hospital Outcomes for Veteran's Socioeconomic Status

> **NIH VA I01** · PROVIDENCE VA  MEDICAL CENTER · 2020 · —

## Abstract

Anticipated Impacts of Veterans' Care: The project will develop and test novel approaches to risk-
adjustment that include Veterans' sociodemographic factors into assessments of VAMC-level hospital
mortality. This contribution is significant because rigorous outcomes measurement is central to VA's strategy to
improve care for Veterans, assess quality across sites, and benchmark performance to the private-sector. If
risk-adjustment fails to account for sociodemographic determinants of mortality that are known to vary across
VA providers, then excluding these factors may penalize VA sites that disproportionately serve vulnerable
patients and generate incorrect inferences about the quality of VA care. Since VA uses performance results for
accountability purposes and to make determinations about allocation of resources, it is essential that VA uses
the most robust risk-adjustment methods available. Given emerging momentum to consider sociodemographic
characteristics for risk-adjustment purposes, there is a pressing need to develop an empirical evidence base
about the implications of such adjustments.
Project Background: Nearly all hospitals in the United States, including all VA Medical Centers (VAMCs),
report mortality rates for hospitalized patients, and performance on these outcomes measures often carry high
stakes. Hospital mortality constitutes two domains of the Strategic Analytic Information and Learning (SAIL)
model that VA employs to evaluate the quality and efficiency of care provided across all VAMCs. Valid hospital
outcome measures must adequately account for differences in clinical risk. Without adequate risk-adjustment,
performance reports may erroneously penalize facilities that serve high-risk populations, or, even worse,
incentivize facilities to admit low-risk patients. Much of the prior concern with risk-adjustment has involved the
source of the data, the selection of appropriate covariates, or the optimal approach to statistical modeling.
Substantially fewer studies have examined the role of socioeconomic status and other sociodemographic
factors in risk-adjustment, though these factors predict worse post-discharge outcomes and vary markedly
across facilities.
Project Objective: The overarching goal of this project is to develop and test novel risk-adjustment
approaches that incorporate Veterans' sociodemographic characteristics into assessments of hospital
mortality. Our aims are: (1) describe VAMC-level variations in the sociodemographic characteristics of
Veterans hospitalized with heart failure and pneumonia; (2) assess the performance of risk-adjustment models
that do and do not include sociodemographic characteristics; and (3) evaluate the impact of incorporating
sociodemographic data on the relative performance of VA Medical Centers.
Project Methods: We propose a retrospective, observational study that will develop and compare alternative
risk-adjustment models predicting mortality within thirty days of admission for heart ...

## Key facts

- **NIH application ID:** 9757603
- **Project number:** 5I01HX002104-03
- **Recipient organization:** PROVIDENCE VA  MEDICAL CENTER
- **Principal Investigator:** AMAL N. TRIVEDI
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-02-01 → 2020-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9757603

## Citation

> US National Institutes of Health, RePORTER application 9757603, Risk-Adjusting Hospital Outcomes for Veteran's Socioeconomic Status (5I01HX002104-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9757603. Licensed CC0.

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