title: Identifying Older Adults with Serious Illness: A Critical Step toward Improving the Value of Health Care.
abstract: To create and test three prospective, increasingly restrictive definitions of serious illness.
  
  
  
  Health and Retirement Study, 2000-2012.
  
  
  
  We evaluated subjects' 1-year outcomes from the interview date when they first met each definition: (A) one or more severe medical conditions (Condition) and/or receiving assistance with activities of daily living (Functional Limitation); (B) Condition and/or Functional Limitation and hospital admission in the last 12 months and/or residing in a nursing home (Utilization); and (C) Condition and Functional Limitation and Utilization. Definitions are increasingly restrictive, but not mutually exclusive.
  
  
  
  Of 11,577 eligible subjects, 5,297 met definition A; 3,151 definition B; and 1,447 definition C.
  
  
  
  One-year outcomes were as follows: hospitalization 33 percent (A), 44 percent (B), 47 percent (C); total average Medicare costs $20,566 (A), $26,349 (B), and $30,828 (C); and mortality 13 percent (A), 19 percent (B), 28 percent (C). In comparison, among those meeting no definition, 12 percent had hospitalizations, total Medicare costs averaged $7,789, and 2 percent died.
  
  
  
  Prospective identification of older adults with serious illness is feasible using clinically accessible criteria and may be a critical step toward improving health care value. These definitions may aid clinicians and health systems in targeting patients who could benefit from additional services.
authors.affiliation: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.|Geriatric Research Education and Clinical Centers, James J Peters VA Medical Center, Bronx, NY.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Kelley
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Covinsky
authors.affiliation: University of Chicago Harris School of Public Policy, Chicago, IL.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Gorges
authors.affiliation: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Karen
authors.initials: K
authors.lastname: McKendrick
authors.affiliation: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Evan
authors.initials: E
authors.lastname: Bollens-Lund
authors.affiliation: Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.|Geriatric Research Education and Clinical Centers, James J Peters VA Medical Center, Bronx, NY.
authors.forename: R Sean
authors.initials: RS
authors.lastname: Morrison
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Ritchie
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D042241:Early Diagnosis; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000706:statistics & numerical data; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration / Q000592:standards; D014481:United States
keywords: Medicare; geriatrics; palliative medicine; population health