Disability and Decline in Physical Function Associated with Hospital Use at End of Life

Kelley, Amy S.; Ettner, Susan L.; Du, Qingling; Sarkisian, Catherine A.

doi:10.1007/s11606-012-2013-9

Cited by 40 publications

(39 citation statements)

References 35 publications

(30 reference statements)

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“…22,23 Yet diagnoses alone fail to adequately predict costs, hospital use, mortality, or, most importantly, unmet care needs. 1,3,24,25 The addition of functional status measures and prior healthcare utilization to identification algorithms may add predictive strength, but clearly defined criteria and consistent data are lacking. 1,25 This article aims to build upon prior work by conceptually defining serious illness and describing the steps needed to operationalize this definition within a healthcare population.…”

Section: Introductionmentioning

confidence: 99%

“…1,3,24,25 The addition of functional status measures and prior healthcare utilization to identification algorithms may add predictive strength, but clearly defined criteria and consistent data are lacking. 1,25 This article aims to build upon prior work by conceptually defining serious illness and describing the steps needed to operationalize this definition within a healthcare population. [26][27][28][29][30] We align these methods with current alternative payment model (APM) proposals 31,32 and highlight critical challenges and tensions in specifying the approach.…”

Section: Introductionmentioning

confidence: 99%

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Identifying the Population with Serious Illness: The “Denominator” Challenge

KelleyAmy

Bollens-LundEvan

2018

Journal of Palliative Medicine

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166

118

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Background: To ensure seriously ill people and their families receive high-quality primary and specialty palliative care services, rigorous methods are needed to prospectively identify this population. Objective: To define and operationalize a definition of serious illness for the purpose of identifying patients and caregivers who need primary or specialty palliative care services. Design/Setting: Two stages of work included (1) building expert consensus around a conceptual definition of serious illness and (2) using the National Health and Aging Trends Study linked to Medicare claims data to test a range of operational definitions composed of diagnoses, utilization, and markers of care needs. Measurements: One-year outcomes included mean total Medicare costs, mortality, and percent hospitalized, as well as those reporting ‡2 measures of need and functional impairment. Sensitivity, specificity, and c-statistics (unadjusted and adjusted for age, sex, race, and Medicaid status) were calculated for each definition across the outcomes. Results: Conceptually, ''Serious illness'' is a health condition that carries a high risk of mortality AND either negatively impacts a person's daily function or quality of life, OR excessively strains their caregivers. The range of operational definitions simulated all had low sensitivity and high specificity across all outcomes. None of the definitions reached an unadjusted c-statistic >0.6 (or adjusted >0.7) for identifying a population with ‡2 indicators of care needs. Conclusions: Standard administrative data are inadequate to identify this population. Defining the seriously ill denominator with high specificity, as described here, will focus efforts toward the highest-need segment of the population, who may indeed benefit most.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Identifying the Population with Serious Illness: The “Denominator” Challenge

KelleyAmy

Bollens-LundEvan

2018

Journal of Palliative Medicine

Self Cite

166

118

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“…In particular, functional limitations and debility are major predictors of health services utilization, yet are not available in claims data. 17,31 Therefore, the Centers of Medicare and Medicaid Services (CMS) should require the collection of functional status data with all inpatient, skilled nursing facility, home health, and hospice Medicare claims. Functional status measures are already collected for clinical purposes in all of these settings.…”

Section: Figmentioning

confidence: 99%

Epidemiology of Care for Patients with Serious Illness

Kelley

2013

Journal of Palliative Medicine

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The U.S. health care system is struggling to improve the quality of health care while containing costs. The rapidly expanding population of older adults with serious illness presents both the greatest challenge and potentially the greatest opportunity to achieving this goal. In order to capitalize on this opportunity, we must first examine the epidemiology of the care of older adults with serious illness, that is, a full description of the characteristics and quality of care from the time of diagnosis through the full course of illness, including measurement of all factors that may influence or impact that care. Several methodological challenges exist in this area of study, including but not limited to, defining the onset of serious illness, avoiding bias in sample selection, and measuring the full breadth of personal, social, local, regional and provider factors that may influence care. Yet, this work is possible through a combination of targeted primary research and efficient leveraging of ongoing studies and existing data sources. Through these studies, we may identify those factors and services associated with high value health care, and learn to develop and refine policies and health care delivery models that yield the greatest improvements in care for seriously ill older patients and their families.

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“…We chose to study hospital-based health care use under Medicare because it is (1) a clinically meaningful measure of severity of illness (i.e., lesser illnesses can be treated in the outpatient setting), (2) something most elderly patients wish to avoid, 17,18 (3) a risk factor for iatrogenic processes including life-threatening infections, 19 (4) a risk factor for functional decline, 20 (5) easily measured in Medicare data, and (6) being used empirically in Medicare-based CER of adjuvant chemotherapy regimens as a measure of treatment-related toxicity. 21 Specifically, we assess elderly Medicare patients treated on two adjuvant chemotherapy trials for breast and colon cancer and evaluate for associations between the burden of CTC AEs they incurred while in the clinical trials and the amount of hospital-based health care they used during the same period.…”

Section: Introductionmentioning

confidence: 99%

Hospital-based health care use correlates with incidence of adverse events among elderly Medicare patients treated in adjuvant chemotherapy trials (Alliance 70802)

Lamont

et al. 2014

Journal of Geriatric Oncology

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Objective Medicare claims can be useful in chemotherapy-related comparative effectiveness research (CER) estimating survival, but methods for estimating patients’ treatment morbidity are currently lacking. We sought to determine if patients’ health care use in the claims is a marker of treatment morbidity. Materials and Methods For 249 elderly Medicare patients with breast or colon cancer who were treated in two adjuvant clinical trials, we merged patients’ National Cancer Institute Common Toxicity Criteria for Adverse Events (CTC AEs) trial data with their contemporaneous Medicare claims. We estimated associations of patients’ grade ≥3 CTC AE counts and their use of two types of hospital-based health care in claims (i.e., emergency room (ER) visits and hospitalizations). Results ER visits and hospitalizations were significantly positively associated with grade ≥3 CTC AE counts incurred by patients during the study. Eight percent of patients without any grade ≥3 CTC AEs had one or more hospitalizations during the observation period compared to 43% of patients with three or more grade ≥3 CTC AEs (p < 0.01). Those who were hospitalized at least once had more than three times the rate of grade ≥3 CTC AEs (IRR 3.70, 95% CI: 2.53–5.40) compared to those who were not. With each hospitalization, the daily incidence rate of any grade ≥3 CTC AE more than doubled (IRR 2.10, 95% CI: 1.54–2.86). Conclusions Because hospitalization is strongly associated with clinically significant toxicity it may be a useful outcome for Medicare claim-based CER comparing treatment morbidity for elderly patients receiving different adjuvant chemotherapy regimens.

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Disability and Decline in Physical Function Associated with Hospital Use at End of Life

Cited by 40 publications

References 35 publications

Identifying the Population with Serious Illness: The “Denominator” Challenge

Identifying the Population with Serious Illness: The “Denominator” Challenge

Epidemiology of Care for Patients with Serious Illness

Hospital-based health care use correlates with incidence of adverse events among elderly Medicare patients treated in adjuvant chemotherapy trials (Alliance 70802)

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