Article demonstrates the effects of risk adjustment for a set of home care quality indicators (HCQIs) based on items in the Minimum Data Set for Home Care. Risk adjustment attempts to adjust for different populations of clients who may be at a greater risk for experiencing quality issues that are a function of their clinical status rather than the quality of care. Data from a total of 22 home care providers in Ontario and the Winnipeg Regional Health Authority (WRHA) in Manitoba, Canada were used to generate HCQIs for each agency and for the 2 regions. The HCQIs represent outcome measures that document an agency's rate for triggering on a quality issue. Three types of risk adjustment methods were contrasted: (1) client covariates only, (2) client covariates plus an Agency Intake Profile (AIP), and (3) client covariates plus the intake case mix index. Across the 19 risk-adjusted HCQIs, Ontario providers had a significantly higher AIP adjustment value for 8 HCQIs. On average, Ontario had unadjusted rates that were 0.3 percent higher than the WRHA. Following risk adjustment with the AIP covariate, Ontario rates were 1.5 percent lower than the WRHA. In the WRHA, individual agencies were likely to experience a decline in their standing following risk adjustment, while the opposite was true for sites in Ontario.

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