ABSTRACT
Any team or organisation that implements an outcome management strategy needs to take account of variation between patients and the risk this poses to the achievement of outcomes. Up until this point, a direct and unambiguous relation has been assumed between a specific intervention and the subsequent outcomes. In reality, however, a number of factors other than the intervention itself can influence the outcome of care. Factors related to patient characteristics appear to play a particularly important role. Differences in age, sex, severity of the disorder, comorbidity and the consequences of therapeutic interventions are all reasons for why outcomes can vary between patients (Shin and Johnson 2000a). Outcomes must thus be adjusted for these factors. Risk adjustment is the process by which the factors that influence care outcomes are taken into consideration in assessing potential outcomes. The goal of risk adjustment is to consider the relevant patient variables before relations are drawn between the effectiveness or quality of care and patient outcomes (Iezonni 1997). Other terms for risk adjustment are severity adjustment, case-mix adjustment, comparison of apples and oranges and levelling of the playing field (Shin and Johnson 2000a).
