Risk adjustment of Florida mental health outcomes data: Concepts, methods,and results

This article discusses outcome evaluation systems for mental health program s. It reviews and critically evaluates design and analysis methods,for stre ngthening the validity of such uncontrolled comparisons. The article examin es methods,fbr statistically adjusting preexisting groups, now referred to as risk adjustment or case-mix adjustment, and offers guidelines for determ ining when this procedure is appropriate. Then, analyses on two dependent v ariables-a global rating of functioning and a consumer satisfaction measure -available from an outcomes evaluation system currently underway in Florida are used to demonstrate the proposed method of risk adjustment. Results fo r 24 providers of mental health services showed that while risk adjustment only made a small difference in the overall provider rankings, the ranking of some specific providers changed considerably. The article concludes with a discussion of the implications of this research.