Identifying Older Adults with Serious Illness: A Critical Step toward Improving the Value of Health Care.

TitleIdentifying Older Adults with Serious Illness: A Critical Step toward Improving the Value of Health Care.
Publication TypeJournal Article
Year of Publication2017
AuthorsKelley, A, Covinsky, KE, Gorges, RJean, McKendrick, K, Bollens-Lund, E, R Morrison, S, Ritchie, CS
JournalHealth Serv Res
Date Published2017 02
ISSN Number1475-6773
KeywordsActivities of Daily Living, Aged, Aged, 80 and over, Critical Illness, Early Diagnosis, Female, Health Care Costs, Hospitalization, Humans, Male, Medicare, Nursing homes, Prospective Studies, Quality Improvement, United States

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.

User Guide Notes

Endnote Keywords

Medicare; geriatrics; palliative medicine; population health

Alternate JournalHealth Serv Res
Citation Key8483
PubMed ID26990009
PubMed Central IDPMC5264106
Grant ListK07 AG031779 / AG / NIA NIH HHS / United States
K23 AG040774 / AG / NIA NIH HHS / United States
K24 AG022345 / AG / NIA NIH HHS / United States