Phase 6: Identification and Testing of Risk Adjusters

Phase #6 seeks to review, catalog and evaluate variables used as risk adjusters of HCBS outcome measures in the current literature. The project is designed in three phases in order to:

  • Identify and catalog risk adjusters used in the current HCBS research relevant to people with different types of the disabilities;  
  • Prioritize a set of risk adjusters to be used in the HCBS measurement process across targeted disability populations; and,
  • Develop models to predict specific HCBS outcomes to increase the validity of the measurement results.

This study began with a systematic review of the peer reviewed literature on HCBS outcomes across targeted disability populations. To meet inclusion criteria, each article needed to contain at least one risk adjuster variable at an individual or a system level that was used to help explain an HCBS outcome(s). Qualifying articles underwent a thorough review of their method sections. The study team recorded information regarding the population type, response options, and citations for any validated instruments used. Key data elements collected included the statistical effect size, the percent of variance explained, and significance-level. Findings were then cataloged by:

  • Disability population
  • HCBS domain area 
  • Risk adjuster domain area
  • Level of risk adjuster (e.g., individual, system, or state)

This data will be made publicly available by way of being included in a searchable web-based database built for the project.

Currently, we are in the process of consulting with expert researchers across intellectual and developmental disability, physical disability, mental health, traumatic brain injury and age-related disability via an online survey to identify and rank the most important risk adjusters based on priority ratings. We have begun the process of combining this information with the information in the database. Ultimately, we intend to use the priority ratings to select the most important and promising risk adjustors to include for testing along with HCBS outcomes measures in Phase #5.

We wish to acknowledge the efforts of Dr. Derek Nord, Director of Indiana University UCEDD  in developing the original proposal including justification, methods, and protocol for this study.