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Identifying Older Adults at High Risk of Mortality Using the Medicare Health Outcomes Survey

Ng, Judy H. PhD; Elliott, Marc N. PhD; Scholle, Sarah Hudson DrPH; Ahmed, Kazi PhD; Collins, Rachel L. MPH; Bierman, Arlene S. MD, MS

Journal of Ambulatory Care Management: October/December 2012 - Volume 35 - Issue 4 - p 277–291
doi: 10.1097/JAC.0b013e3182674721
Original Articles

The Vulnerable Elders Survey (VES), a screening tool for at-risk elderly, has been validated in the community. This study used VES-based criteria to develop a modified version that can be calculated from the Medicare Health Outcomes Survey (HOS) to identify Medicare members at high risk of mortality. Data were from 97,258 HOS respondents in 164 plans. Using age, self-rated health, and function items from the 2005 HOS, an a priori approach modeled on VES scoring and items predicted two-year mortality (c-statistic 0.74). Routinely-collected Medicare survey data may be used to assess patterns of enrollment of high-risk beneficiaries across health plans.

The National Committee for Quality Assurance, Washington, DC (Dr Ng, Scholle, Ahmed and Collins), RAND Corporation, Santa Monica, CA (Dr Elliott), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Faculties of Nursing and Medicine, University of Toronto, Toronto, Ontario (Mr Bierman).

Correspondence: Judy H. Ng, Research Scientist, The National Committee for Quality Assurance, 1100 13th Street, NW, Suite 1000, Washington, DC 20005 (ng@ncqa.org). (Alternate corresponding author: Sarah Hudson Scholle, The National Committee for Quality Assurance, 1100 13th Street, NW, Suite 1000, Washington, DC 20005 (scholle@ncqa.org.)

Conflicts of Interest and Source of Funding: The authors do not have any conflicts of interest to declare, except for employment by the National Committee for Quality Assurance, which administers the Medicare Health Outcomes Survey for the Centers for Medicare & Medicaid Services. This study was supported by the Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services (HHSM-500-2004-00015I-0001).

We thank Samuel C. Haffer and Sonya Bowen for their leadership and feedback throughout the course of this project, and Janet Holzman, Judy Lacourciere, and Cheryl Kovalsky for their management and editorial support. Details on the Vulnerable Elders Survey are available from Saliba et al., 2001 and online at: http://www.rand.org/health/projects/acove/survey.html. The views expressed in this article are the authors' and do not necessarily represent the views of the U.S. Department of Health and Human Services, or Centers for Medicare & Medicaid Services.

© 2012 Lippincott Williams & Wilkins, Inc.