Identification and assessment of high-risk seniors. HMO Workgroup on Care Management.
BACKGROUND
Many older adults with chronic illnesses and multidimensional needs are at high risk of adverse health outcomes, poor quality of life, and heavy use of health-related services. Modern proactive care of older populations includes identification of such high-risk individuals, assessment of their health-related needs, and interventions designed both to meet those needs and to prevent undesirable outcomes.


OBJECTIVE
This paper outlines an approach to the tasks of identifying and assessing high-risk seniors. Intervention identification of high-risk seniors (also called case finding) is accomplished through a combination of periodic screening, recognition of high-risk seniors by clinicians, and analysis of administrative databases. Once identified, potentially high-risk individuals undergo on initial assessment in eight domains: cognition, medical conditions, medications, access to care, functional status, social situation, nutrition, and emotional status. The initial assessment is accomplished in a 30- to 45-minute interview conducted by a skilled professional--usually one with a background in nursing. The data are used to link some high-risk persons with appropriate services and to identify others who require more detailed assessments. Detailed assessment is often performed by interdisciplinary teams of various compositions and methods of operation, depending on local circumstances.


CONCLUSIONS
The rapid growth in Medicare managed care is presenting many opportunities for developing more effective strategies for the proactive care for older populations. Identification and assessment of high-risk individuals are important initial steps in this process, paving the way for testing of interventions designed to reduce adverse health consequences and to improve the quality of life.
Boult
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University of Minnesota Medical School, Minneapolis, MN, USA.
Pualwan
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TF
Fox
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PD
Pacala
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JT
D000203:Activities of Daily Living; D000368:Aged; D019090:Case Management; D002908:Chronic Disease / Q000453:epidemiology; D003266:Continuity of Patient Care / Q000458:organization & administration; D015577:Geriatric Assessment; D006265:Health Care Coalitions; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand; D006305:Health Status Indicators; D006801:Humans; D007407:Interviews as Topic; D006278:Medicare / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology