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

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.

Keywords: Medicare; geriatrics; palliative medicine; population health.

Figure 1

Three Definitions of Serious Illness, Ranging from Broad to Restrictive

Figure 2

Status at Two‐Year Follow‐Up, as Percentage of Criteria Group