American journal of medical quality : the official journal of the American College of Medical Quality
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The effectiveness of risk adjustment in improving mortality as a performance measure for hospitals remains uncertain. New techniques of risk adjustment should be empirically tested, and health care professionals, using the data derived from such measures, should be queried before final acceptance of these technologies of measurement is warranted. The Risk Adjusted Clinical Outcomes Methodology-Quality Measures (RACOM-QM), a relatively new risk-adjustment methodology developed by the QuadraMed Corporation, was used by Maryland hospitals for risk adjustment for the first time in 1997. ⋯ This study provides overall support for the usefulness of risk adjustment and, specifically, the RACOM-QM, in increasing the interpretation of inpatient mortality rates in Maryland's acute care hospitals. This study also suggests that use of the RACOM-QM improved comparative analysis of inpatient mortality rates among Maryland hospitals. Finally, the results of the case study analysis suggest that improved internal review of mortality rates and increased clinician acceptance of these rates as indicators of performance were enhanced by the use of a risk adjustment methodology.