Published in: Medical Care, v. 40, no. 9, Sep. 2002, p. 782-793
Posted on RAND.org on January 01, 2002
This article was published outside of RAND. The full text of the article can be found at the link above.
BACKGROUND. A small percentage of older persons account for most Medicare costs. If persons at high risk for high health care utilization can be identified, resources can be directed to improve their health care and reduce utilization. OBJECTIVE. To develop an efficient and economical approach to identifying older persons at risk for high future health care utilization. DESIGN. Validation cohort. SETTING. Three communities. SUBJECTS. Five thousand one hundred thirty-eight community-dwelling persons aged 71 years or older. MAIN OUTCOME MEASURES. High utilization (defined as >11 hospital days during 3 years) and overall Part A Medicare hospital costs during 3 years. RESULTS. Predictive multivariable models were created that relied on prior hospitalization only, self-report only, and combined self report and physical examination/lab data. Ten self-report items (hospitalizations in prior year and year before that, male gender, fair/poor health, not working, infrequent religious participation, needing help bathing, unable to walk 1/2 mile, diabetes, and taking loop diuretics) and two lab tests (low serum albumin and iron) remained as independent predictors of high utilization. Based upon these variables, approximately 1.4 of the population was identified as being at high risk (>0.28 probability) for high health care utilization and those identified accounted for approximately half of all Medicare Part A costs for the entire population. Finally, a two-phase strategy was developed in which tests are only administered to individuals whose risk cannot be adequately determined by self-report variables (approximately 1.4 of subjects). CONCLUSIONS. Simple questions and laboratory tests can accurately and efficiently identify seniors at high risk for high health care utilization.
This article was published outside of RAND. The full text of the article can be found at the link above.
This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.
Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/research-integrity.
The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.