title: Mortality risk and prospective medicare expenditures for persons with dementia.
abstract: OBJECTIVE
  To determine whether an index that stratifies dementia patients into high- and low-mortality-risk groups can be effective in prospectively identifying persons with high and low expenditures.
  
  
  METHODS
  A mortality risk index developed for persons with dementia was used to stratify persons into groups at high and low risk of 12-month mortality. Expenditures were compiled from Medicare claims for 12 months after the predicted mortality classification.
  
  
  METHODS
  The Medicare Alzheimer's Disease Demonstration Evaluation (MADDE) operated in eight sites across the United States. Subjects were living in a community setting at time of their mortality risk classification.
  
  
  METHODS
  Participants (N=2,255) were volunteer enrollees in MADDE; all had a diagnosis of irreversible dementia and two or more limitations in activities of daily living (ADLs).
  
  
  METHODS
  Outcomes were Medicare Part A expenditures. Risk factors included age, sex, ADL limitations, selected chronic conditions, prior year hospital stays, and relationship to caregiver.
  
  
  RESULTS
  Patients predicted as at high risk of death had higher average monthly Medicare expenditures than those predicted to be at low risk of death. At the 50th sensitivity percentile for mortality, differences in average expenditures exceeded 700 dollars per month.
  
  
  CONCLUSIONS
  It is not known whether it is possible to achieve reductions in expenditures for patients with advanced dementia at high risk of mortality, but study findings support consideration of an advanced illness model that would attempt to generate acute services savings and use these savings for palliative services that might improve patients' and caregivers' quality of life.
authors.affiliation: Department of Social and Behavioral Science, University of California at San Francisco, San Fransisco, California 94118, USA. Robert.Newcomer@ucsf.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Newcomer
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Clay
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Covinsky
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000191:economics / Q000401:mortality*; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D012306:Risk; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014481:United States