Identifying distinct risk profiles to predict adverse events among community-dwelling older adults
Melissa O'Connor, Alexandra Hanlon, Elizabeth Mauer, Salimah Meghani, Ruth Masterson-Creber, Sherry Marcantonio, Ken Coburn, Janet Van Cleave, Joan Davitt, Barbara Riegel, Kathryn H Bowles, Susan Keim, Sherry A Greenberg, Justine S Sefcik, Maxim Topaz, Dexia Kong, Mary Naylor, Melissa O'Connor, Alexandra Hanlon, Elizabeth Mauer, Salimah Meghani, Ruth Masterson-Creber, Sherry Marcantonio, Ken Coburn, Janet Van Cleave, Joan Davitt, Barbara Riegel, Kathryn H Bowles, Susan Keim, Sherry A Greenberg, Justine S Sefcik, Maxim Topaz, Dexia Kong, Mary Naylor
Abstract
Preventing adverse events among chronically ill older adults living in the community is a national health priority. The purpose of this study was to generate distinct risk profiles and compare these profiles in time to: hospitalization, emergency department (ED) visit or death in 371 community-dwelling older adults enrolled in a Medicare demonstration project. Guided by the Behavioral Model of Health Service Use, a secondary analysis was conducted using Latent Class Analysis to generate the risk profiles with Kaplan Meier methodology and log rank statistics to compare risk profiles. The Vuong-Lo-Mendell-Rubin Likelihood Ratio Test demonstrated optimal fit for three risk profiles (High, Medium, and Low Risk). The High Risk profile had significantly shorter time to hospitalization, ED visit, and death (p < 0.001 for each). These findings provide a road map for generating risk profiles that could enable more effective targeting of interventions and be instrumental in reducing health care costs for subgroups of chronically ill community-dwelling older adults.
Keywords: Chronic illness; Community-dwelling older adults; Latent class analysis; Nurse care management model; Risk profiles.
Copyright © 2017 Elsevier Inc. All rights reserved.
Figures
![Fig. 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5991797/bin/nihms970482f1.jpg)
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Fig. 4
Time to first emergency department…
Fig. 4
Time to first emergency department visit Kaplan Meier curve by class with survival…
Fig. 5
Overall survival Kaplan Meier curve…
Fig. 5
Overall survival Kaplan Meier curve by class with survival probabilities, log-rank (p
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- Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare.Amjad H, Carmichael D, Austin AM, Chang CH, Bynum JP. Amjad H, et al. JAMA Intern Med. 2016 Sep 1;176(9):1371-8. doi: 10.1001/jamainternmed.2016.3553. JAMA Intern Med. 2016. PMID: 27454945 Free PMC article.
- The community assessment risk screen (CARS): identifying elderly persons at risk for hospitalization or emergency department visit.Shelton P, Sager MA, Schraeder C. Shelton P, et al. Am J Manag Care. 2000 Aug;6(8):925-33. Am J Manag Care. 2000. PMID: 11186504
- Chronic Disease / nursing*
- Emergency Service, Hospital / statistics & numerical data
- Female
- Hospitalization
- Humans
- Independent Living*
- Male
- Medicare
- Outcome Assessment, Health Care*
- Risk Assessment
- United States
- Full Text Sources
- Other Literature Sources
- Medical
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![Fig. 4](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5991797/bin/nihms970482f4.jpg)
Fig. 5
Overall survival Kaplan Meier curve…
Fig. 5
Overall survival Kaplan Meier curve by class with survival probabilities, log-rank (p
- Using the past to predict the future: latent class analysis of patterns of health service use of older adults in the emergency department.Hastings SN, Whitson HE, Sloane R, Landerman LR, Horney C, Johnson KS. Hastings SN, et al. J Am Geriatr Soc. 2014 Apr;62(4):711-5. doi: 10.1111/jgs.12746. Epub 2014 Mar 17. J Am Geriatr Soc. 2014. PMID: 24635112 Free PMC article.
- Evaluation of a primary care nurse case management intervention for chronically ill community dwelling older people.Schraeder C, Fraser CW, Clark I, Long B, Shelton P, Waldschmidt V, Kucera CL, Lanker WK. Schraeder C, et al. J Clin Nurs. 2008 Nov;17(11c):407-17. doi: 10.1111/j.1365-2702.2008.02578.x. J Clin Nurs. 2008. PMID: 26327423
- Frequency and predictors of adverse health outcomes in older Medicare beneficiaries discharged from the emergency department.Hastings SN, Oddone EZ, Fillenbaum G, Sloane RJ, Schmader KE. Hastings SN, et al. Med Care. 2008 Aug;46(8):771-7. doi: 10.1097/MLR.0b013e3181791a2d. Med Care. 2008. PMID: 18665056
- Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare.Amjad H, Carmichael D, Austin AM, Chang CH, Bynum JP. Amjad H, et al. JAMA Intern Med. 2016 Sep 1;176(9):1371-8. doi: 10.1001/jamainternmed.2016.3553. JAMA Intern Med. 2016. PMID: 27454945 Free PMC article.
- The community assessment risk screen (CARS): identifying elderly persons at risk for hospitalization or emergency department visit.Shelton P, Sager MA, Schraeder C. Shelton P, et al. Am J Manag Care. 2000 Aug;6(8):925-33. Am J Manag Care. 2000. PMID: 11186504
- Chronic Disease / nursing*
- Emergency Service, Hospital / statistics & numerical data
- Female
- Hospitalization
- Humans
- Independent Living*
- Male
- Medicare
- Outcome Assessment, Health Care*
- Risk Assessment
- United States
- Full Text Sources
- Other Literature Sources
- Medical
![Fig. 5](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/5991797/bin/nihms970482f5.jpg)
Source: PubMed