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

Kelley, Melinda S.; Covinsky, M.P.H. Kenneth E.; Gorges, Rebecca J.; McKendrick, Karen; Bollens‐Lund, Evan; Morrison, R. Sean; Ritchie, Michelle

doi:10.1111/1475-6773.12479

Cited by 98 publications

(109 citation statements)

References 20 publications

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“…3,4 Many high-cost patients experience high levels of spending over multiple years. 27,34 By purposefully targeting the end of life, programs may miss or curtail the opportunity to meaningfully improve care and reduce burdensome or inappropriate utilization. Furthermore, hospice services are specifically targeted to patients in the last months of life, whereas palliative care services may be appropriate at any stage of illness.…”

Section: Defining the Populationmentioning

confidence: 99%

“…The first approach is drawn from the Dartmouth Atlas of Healthcare and identifies nine serious chronic conditions, associated with about 90% of all deaths, by using only diagnosis codes. 37, 38 The second more complex approach is modified from prior work to identify the seriously ill, 27 and uses diagnosis codes and additional claimsbased elements to provide evidence of advanced disease (e.g., COPD only if using home oxygen or as primary diagnosis on hospital admission). In practice, these diagnoses could be identified through claims data, EHR or billing data, or patient report.…”

Section: Components Of the Approachmentioning

confidence: 99%

“…Such entities are able to access the data needed for the more complex approach to indentifying serious medical conditions, 27 and this combined system-wide collection of function data or telephonic screening would replicate the approach with the greatest sensitivity (Fig. 3).…”

Section: S-12 Kelley and Bollens-lundmentioning

confidence: 99%

“…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. To illustrate these issues, we also describe simulated examples of population identification methods using a nationally representative cohort of Medicare beneficiaries.…”

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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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: Defining the Populationmentioning

confidence: 99%

Section: Components Of the Approachmentioning

confidence: 99%

Section: S-12 Kelley and Bollens-lundmentioning

confidence: 99%

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

Self Cite

166

118

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“…Persons with serious illness are a subset of this population and characterized by having progression of end‐organ disease (eg, heart, lung, kidney) or incurable conditions such as advanced cancer or dementia. Persons with serious illness face declines in health and functional status, dependency on caregivers, and generate extraordinary healthcare costs . These patient populations have complex care needs, such as difficulty in accessing care, and healthcare systems and stakeholders are looking to evolving community‐based care models that have the capacity for (1) integrating the fragmentation of primary, specialty, and hospice care services across care delivery sites; (2) engaging and coordinating social and community‐based services with medical care; and (3) providing support for family and other caregivers…”

mentioning

confidence: 99%

The Impact of a Community‐Based Serious Illness Care Program on Healthcare Utilization and Patient Care Experience

Daaleman

Ernecoff

Kistler

et al. 2019

J American Geriatrics Society

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OBJECTIVE Healthcare organizations are expanding community‐based serious illness care programs to deliver care for homebound patients. Programs typically focus on home‐based primary care or home‐based palliative care, yet this population may require both services. We developed and evaluated a primary and palliative care program serving seriously ill older adults, called the Reaching Out to Enhance the Health of Adults in Their Communities and Homes (REACH) program. Our objective was to determine the impact of the REACH program on healthcare utilization and the patient care experience. DESIGN Case study using medical record review and telephone interviews. SETTING Home‐based serious illness care program in central North Carolina. PARTICIPANTS Patients enrolled in the REACH program from August 2014 to March 2016 (n = 159). INTERVENTION Home‐based primary and palliative care delivered by an interdisciplinary team for seriously ill older adults. MEASUREMENTS Structured medical record review including demographics, health and functional status, and acute hospitalization and emergency department (ED) visits in the 12 months preceding and following initiation of the REACH program. A convenience sample of participants completed telephone interviews that measured the quality‐of‐care experience and quality of communication. RESULTS REACH patients had a 43% reduction in hospital visits and a 25% reduction in ED visits. Participants in telephone interviews reported a high‐quality care experience and very good quality of communication with REACH providers. CONCLUSION A care model that integrates home‐based primary care and palliative care has the potential to reduce health service utilization and enhance the care experience for older patients with serious illness. J Am Geriatr Soc 67:825–830, 2019.

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