INITIAL EVIDENCE ON FRAILTY ASSESSMENT IMPROVING RISK PREDICTION AMONG PACE PARTICIPANTS

• Published in: Innovation in aging 2017-07, Vol.1 (suppl_1), p.1131-1131
• Main Authors: Xue, Q., Barron, J., McNabney, M.
• Format: Article
• Language: English
• Subjects: Abstracts
• ISSN: 2399-5300; 2399-5300
• DOI: 10.1093/geroni/igx004.4134

The Program for All-inclusive Care for the Elderly (PACE) is a community-based model serving high-risk older adults who meet their state’s nursing home eligibility criteria but prefer living in the community. Despite some population-level evidence of benefits of the PACE in reducing healthcare utilization and expenditure, nursing home transition, and mortality compared to the usual fee-for-service care models, the question of who would benefit the most remains unclear. We hypothesize that frailty as a measure of late-life vulnerability is a better risk predictor of certain types of health care utilization than disease burden alone. To test this, a pilot study was conducted to assess the associations of frailty (vs. the Hierarchical Condition Categories (HCC)) for predicting number of ED visits and days of hospitalization among PACE participants. Of the 27 subjects selected from the Hopkins PACE program, 82% were female, 70% were African Americans, and 4% (n=1), 52% (n=14), 44% (n=12), were identified using Fried’s physical frailty phenotype as non-frail, pre-frail and frail, respectively. Using Poisson regression, we found that the incidence rates of ED visits and hospitalization in the frail were respectively 4.3 (p=0.026) and 4.2 (p=0.027) times the corresponding incidence rates in the pre-frail after adjusting for age. The associations remained significant after additionally adjusting for HCC. In contrast, HCC alone was not significantly associated with the same outcomes. These findings suggest that incorporating frailty assessment in the PACE program may improve risk prediction, thereby offering new opportunities for improving patient-specific outcomes and controlling health care expenditures.