142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

300554
Robust Mortality Prediction Approach for Identifying Vulnerable Seniors Using the Medicare Health Outcomes Survey

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Marc N. Elliott, PhD , RAND Health, RAND, Santa Monica, CA
Megan Beckett, PhD , RAND Health, RAND Corporation, Santa Monica, CA
Douglas Ritenour, MPH , Health Services Advisory Group, Phoenix, AZ
Laura Giordano, RN, MBA , Health Services Advisory Group, Phoenix, AZ
Susan Grace, RN, BSN , Health Services Advisory Group, Phoenix, AZ
Rochelle Malinoff, MBA, PhD. , Health Services Advisory Group, Phoenix, AZ

Using 2009 data from 238,687 seniors, we modified a validated predictive model for identifying high mortality risk seniors [Vulnerable Elders Survey (VES-13)] using items from the Medicare Health Outcomes Survey (HOS). We assessed whether the approach was robust to substitution of similar survey items and could be used in the presence of missing data.  We computed a risk score (using age, self-rated health, physical functioning limitations, and activities of daily living) at baseline using a modified predictive model that substituted new items for several unavailable items used in previously validated versions of the scoring algorithm. We predicted two-year mortality from risk score and other beneficiary characteristics using multivariate models.  We classified 38% of seniors low risk (<3 points), 29% moderate risk (3-6), and 33% high risk (>6).  Each one-point increase in the 0–10 risk score corresponded to 37% higher odds of death (p<0.001). 10.6% of moderate/high-risk seniors died within two years, compared to 2.4% of low-risk seniors, similar to relative risks reported using the original VES-13.  The 16% of HOS respondents with any missing data on the modified VES-13 instrument had a 9.5% mortality rate versus 7% for those without. Predicted mortality under median imputation matched that for cases with no missing data. This modification of the VES-13 that substitutes alternative survey questions performs as well as the original algorithm in predicting older adult mortality, accounts for missing data (a significant concern in surveys of older patients), and is robust to changes in specific survey items. 

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Public health or related public policy
Public health or related research

Learning Objectives:
Assess if a previously validated predictive model for identifying older adults at high risk of mortality is robust to substitution of similar survey items. Determine if the predictive model can be used in the presence of missing data.

Keyword(s): Aging, Risk Factors/Assesment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am or have been the principle investigator of multiple federally-funded health care grants and contracts, am a Fellow of the American Statistical Association, and have authored more than 250 peer-reviewed publications. I was the co-developer of the widely used VES-13 algorithm for predicting mortality and functional decline on which this work is based, and I developed the analytic approach for the work being presented.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.