Identifying Older Adults with Serious Illness: A Critical Step toward Improving the Value of Health Care. (18th March 2016)

• Record Type: Journal Article
• Authors: Kelley, Amy S.; Covinsky, Kenneth E.; Gorges, Rebecca J.; McKendrick, Karen; Bollens‐Lund, Evan; Morrison, R. Sean; Ritchie, Christine S.
• Is Part Of: Health services research. Volume 52:Number 1(2017:Feb.)
• Page Start: 113
• Page End: 131
• Publication Date: 2016-03-18
• Subjects: Medicare -- population health -- geriatrics -- palliative medicine; Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.12479
• Languages: English
• ISSNs: 0017-9124

Abstract

Abstract : Objective: To create and test three prospective, increasingly restrictive definitions of serious illness. Data Sources: Health and Retirement Study, 2000–2012. Study Design: We evaluated subjects' 1‐year outcomes from the interview date when they first met each definition: (A) one or more severe medical conditions (Condition) and/or receiving assistance with activities of daily living (Functional Limitation); (B) Condition and/or Functional Limitation and hospital admission in the last 12 months and/or residing in a nursing home (Utilization); and (C) Condition and Functional Limitation and Utilization. Definitions are increasingly restrictive, but not mutually exclusive. Data Collection: Of 11, 577 eligible subjects, 5, 297 met definition A; 3, 151 definition B; and 1, 447 definition C. Principal Findings: One‐year outcomes were as follows: hospitalization 33 percent (A), 44 percent (B), 47 percent (C); total average Medicare costs $20, 566 (A), $26, 349 (B), and $30, 828 (C); and mortality 13 percent (A), 19 percent (B), 28 percent (C). In comparison, among those meeting no definition, 12 percent had hospitalizations, total Medicare costs averaged $7, 789, and 2 percent died. Conclusions: Prospective identification of older adults with serious illness is feasible using clinically accessible criteria and may be a critical step toward improving health care value. These definitions may aid clinicians and health systems in targeting patients who could benefit from additional services.