Table 4. Predictive Ratios for Alternative Risk Adjustment Models by Subgroup*.
| Validation Group | AAPCC | Prospective Models | Concurrent Models | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
||||||||||
| PIPDCG | ADDCG | HCC | HCCP | HCCPH | PIPDCG | ADDCG | HCC | HCCP | HCCPH | ||
| All Enrollees | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Aged | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Disabled | 1.01 | 1.00 | 1.01 | 1.00 | 1.00 | 1.00 | 0.99 | 1.00 | 0.99 | 1.00 | 0.99 |
| Female, Under 65 Years of Age | 1.01 | 1.00 | 1.01 | 1.01 | 1.01 | 1.01 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Female, 65-69 Years of Age | 1.02 | 1.02 | 1.02 | 1.02 | 1.02 | 1.02 | 1.01 | 1.02 | 1.01 | 1.01 | 1.01 |
| Female, 70-74 Years of Age | 0.99 | 0.98 | 0.99 | 0.99 | 0.99 | 0.99 | 0.99 | 0.99 | 0.99 | 1.00 | 0.99 |
| Female, 75-79 Years of Age | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Female, 80-84 Years of Age | 1.02 | 1.02 | 1.01 | 1.02 | 1.02 | 1.02 | 1.02 | 1.01 | 1.02 | 1.01 | 1.01 |
| Female, 85 Years of Age or Older | 1.01 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.01 | 1.00 | 1.00 | 0.99 | 1.00 |
| Male, Under 65 Years of Age | 0.99 | 0.98 | 1.00 | 0.99 | 0.99 | 0.99 | 0.98 | 1.00 | 0.99 | 1.00 | 0.99 |
| Male 65-69 Years of Age | 1.01 | 1.01 | 1.01 | 1.01 | 1.01 | 1.01 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Male, 70-74 Years of Age | 1.01 | 1.01 | 1.01 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Male, 75-79 Years of Age | 1.00 | 0.99 | 0.99 | 0.99 | 0.99 | 0.99 | 1.00 | 1.00 | 0.99 | 1.00 | 0.99 |
| Male, 80-84 Years of Age | 0.99 | 0.98 | 0.99 | 0.98 | 0.98 | 0.98 | 0.99 | 0.99 | 0.97 | 0.98 | 0.98 |
| Male, 85 Years of Age or Older | 1.00 | 1.00 | 1.00 | 0.99 | 1.00 | 0.99 | 1.00 | 0.99 | 1.00 | 1.00 | 0.99 |
| Any 1991 Chronic Condition | 0.82 | 0.89 | 0.96 | 0.98 | 0.98 | 0.98 | 0.94 | 0.96 | 0.99 | 0.99 | 0.98 |
| Depression | 0.58 | 0.81 | 0.80 | 0.87 | 0.87 | 0.90 | 0.87 | 0.84 | 0.93 | 0.92 | 0.94 |
| Alcohol and Drug Dependence | 0.46 | 0.79 | 0.85 | 0.98 | 0.99 | 0.99 | 0.85 | 0.82 | 0.92 | 0.93 | 0.95 |
| Hypertensive Heart-Renal Disease | 0.69 | 0.83 | 0.89 | 0.93 | 0.94 | 0.94 | 0.87 | 0.90 | 0.97 | 0.97 | 0.95 |
| Benign/Unspecified Hypertension | 0.84 | 0.92 | 0.96 | 0.97 | 0.97 | 0.97 | 0.95 | 0.96 | 0.97 | 0.97 | 0.98 |
| Diabetes With Complications | 0.45 | 0.69 | 0.81 | 0.93 | 0.94 | 0.94 | 0.78 | 0.78 | 0.97 | 0.96 | 0.94 |
| Diabetes Without Complications | 0.63 | 0.75 | 0.85 | 1.02 | 1.02 | 1.02 | 0.87 | 0.88 | 0.99 | 0.99 | 0.97 |
| Heart Failure/Cardiomyopathy | 0.48 | 0.74 | 0.87 | 0.98 | 0.98 | 0.98 | 0.83 | 0.82 | 0.97 | 0.97 | 0.95 |
| Acute Myocardial Infarction | 0.45 | 0.79 | 0.83 | 0.87 | 0.89 | 0.90 | 0.80 | 0.81 | 0.92 | 0.92 | 0.92 |
| Other Heart Disease | 0.66 | 0.82 | 0.88 | 0.97 | 0.97 | 0.98 | 0.89 | 0.90 | 0.98 | 0.98 | 0.96 |
| Chronic Obstructive Pulmonary Disease | 0.61 | 0.80 | 0.82 | 0.98 | 0.98 | 0.98 | 0.88 | 0.87 | 0.99 | 0.99 | 0.96 |
| Colorectal Cancer | 0.54 | 0.76 | 0.87 | 0.93 | 1.00 | 1.00 | 0.82 | 0.91 | 1.01 | 1.02 | 0.96 |
| Breast Cancer | 0.68 | 0.78 | 0.93 | 1.08 | 1.06 | 1.06 | 0.87 | 1.02 | 1.18 | 1.13 | 1.02 |
| Lung or Pancreas Cancer | 0.32 | 0.64 | 0.89 | 0.92 | 0.94 | 0.96 | 0.74 | 0.80 | 0.97 | 0.97 | 0.93 |
| Other Stroke | 0.53 | 0.76 | 0.83 | 0.98 | 0.98 | 0.98 | 0.82 | 0.88 | 1.03 | 1.02 | 0.97 |
| Intracerebral Hemorrhage | 0.40 | 0.66 | 0.72 | 0.86 | 0.89 | 0.89 | 0.74 | 0.78 | 0.94 | 0.93 | 0.88 |
| Hip Fracture | 0.59 | 0.86 | 0.85 | 0.99 | 1.00 | 0.99 | 0.87 | 1.01 | 1.15 | 1.14 | 0.99 |
| Arthritis | 0.78 | 0.85 | 0.92 | 0.91 | 0.91 | 0.91 | 0.94 | 0.93 | 0.93 | 0.92 | 0.95 |
| First (Lowest) Quintile, 1991 Expenditures | 2.49 | 1.92 | 1.22 | 1.30 | 1.26 | 1.27 | 1.51 | 1.23 | 1.09 | 1.11 | 1.18 |
| Second Quintile, 1991 Expenditures | 1.78 | 1.37 | 1.37 | 1.24 | 1.21 | 1.20 | 1.30 | 1.28 | 1.12 | 1.13 | 1.13 |
| Middle Quintile, 1991 Expenditures | 1.31 | 1.01 | 1.24 | 1.14 | 1.11 | 1.09 | 1.13 | 1.19 | 1.13 | 1.12 | 1.08 |
| Fourth Quintile, 1991 Expenditures | 0.91 | 0.78 | 1.02 | 0.99 | 0.97 | 0.95 | 0.98 | 1.03 | 1.05 | 1.04 | 1.01 |
| Fifth (Highest) Quintile, 1991 Expenditures | 0.48 | 0.85 | 0.78 | 0.85 | 0.88 | 0.90 | 0.80 | 0.80 | 0.88 | 0.89 | 0.90 |
| First (Lowest) Quintile, 1992 Expenditures | 821.67 | 684.17 | 522.57 | 514.41 | 505.56 | 506.17 | 185.18 | 116.71 | 81.48 | 86.86 | 54.44 |
| Second Quintile, 1992 Expenditures | 23.03 | 20.43 | 19.94 | 18.66 | 18.44 | 18.35 | 5.24 | 9.11 | 6.57 | 6.49 | 3.18 |
| Middle Quintile, 1992 Expenditures | 6.92 | 6.56 | 7.05 | 6.78 | 6.72 | 6.67 | 1.63 | 4.10 | 3.61 | 3.49 | 1.64 |
| Fourth Quintile 1992 Expenditures | 1.79 | 1.85 | 2.01 | 2.03 | 2.03 | 2.02 | 1.07 | 1.74 | 1.68 | 1.63 | 1.19 |
| Fifth (Highest) Quintile, 1992 Expenditures | 0.24 | 0.31 | 0.32 | 0.34 | 0.35 | 0.35 | 0.88 | 0.68 | 0.74 | 0.75 | 0.91 |
| 0 1991 Hospital Admissions | 1.30 | 1.00 | 1.10 | 1.05 | 1.04 | 1.02 | 1.09 | 1.10 | 1.05 | 1.05 | 1.03 |
| 1 1991 Hospital Admissions | 0.64 | 1.16 | 0.97 | 0.99 | 1.01 | 1.03 | 0.92 | 0.91 | 0.96 | 0.96 | 0.98 |
| 2 1991 Hospital Admissions | 0.46 | 0.97 | 0.82 | 0.91 | 0.94 | 0.97 | 0.84 | 0.83 | 0.92 | 0.92 | 0.94 |
| 3+ 1991 Hospital Admissions | 0.29 | 0.73 | 0.62 | 0.77 | 0.82 | 0.87 | 0.73 | 0.69 | 0.82 | 0.82 | 0.86 |
| 0 1992 Hospital Admissions | 4.51 | 4.21 | 4.18 | 4.09 | 4.06 | 4.04 | 1.00 | 2.35 | 2.07 | 2.07 | 0.99 |
| 1 1992 Hospital Admissions | 0.39 | 0.45 | 0.46 | 0.47 | 0.48 | 0.48 | 1.38 | 0.94 | 0.91 | 0.90 | 1.22 |
| 2 1992 Hospital Admissions | 0.20 | 0.26 | 0.27 | 0.29 | 0.29 | 0.30 | 0.97 | 0.70 | 0.75 | 0.75 | 0.97 |
| 3+ 1992 Hospital Admissions | 0.12 | 0.18 | 0.18 | 0.21 | 0.21 | 0.22 | 0.64 | 0.50 | 0.65 | 0.66 | 0.80 |
*
Ratio of predicted to actual 1992 expenditures.
NOTE: Chronic conditions are defined based on 1991 diagnoses. Prospective risk-adjustment models use 1991 diagnoses, procedures, and hospitalizations. Concurrent models use 1992 information. Predicted and actual expenditures in the predictive ratios are for 1992.
SOURCE: 1991 and 1992 Medicare Claims, 2.5-Percent Validation Sample.