Results Summary

What was the research about?

Many older adults in the United States are living with long-term, or chronic, health problems and disabilities. These health problems and other personal traits, like people’s age or gender, can put people at risk for worse health and disabilities as they age. Some people must move into nursing homes to get the care they need. Being able to predict worsening health could help patients and doctors make healthcare decisions.

In this study, the research team developed statistical models that used Medicare data to identify traits that made an older person with disabilities more likely to have the following worsening health events:

  • Becoming more disabled within two years
  • Moving into a nursing home within two years
  • Dying within two years

What were the results?

According to the statistical models, people with the following traits were more likely to become more disabled, move into a nursing home, or die within two years:

  • Being 85 or older
  • Being male
  • Not living with a spouse
  • Having only Medicare insurance
  • Having Alzheimer’s disease or dementia
  • Having diabetes
  • Being unable to do daily activities

The research team found that risk scores calculated using models that included these traits could predict if a person would have one of the worsening health events within two years.

Who was in the study?

The research team looked at Medicare data for 21,264 people ages 65 and older. Among these people, 56 percent were ages 65 to 74, 34 percent were 75 to 84, and 10 percent were 85 and older. Also, 56 percent were women, 82 percent were white, 8 percent were black, and 7 percent were Hispanic.

What did the research team do?

First, the research team conducted group interviews with doctors and people with and without disabilities. The interviews were about experiences with the healthcare system, problems getting care, and how having disabilities affects care. The interviews helped the team learn what traits to include in the statistical models.

Next the research team looked at the traits of people who became more disabled, moved into a nursing home, or died within two years. The team used these details to create the models. The models allowed the team to create a risk score that can be used to predict a person’s risk of having one of the worsening health events within two years.

What were the limits of the study?

The results only apply to people who are 65 and older and have Medicare. The models only showed that having certain traits increases the chance of becoming more disabled, moving into a nursing home, or dying. The models didn't show that the traits caused these events.

Future research could explore how well the statistical models work to identify older patients most in need of care to prevent worsening health.

How can people use the results?

Doctors could use statistical models to see which patients are at risk for worsening health. Older people with disabilities and their doctors could consider using risk scores to help manage care.

Final Research Report

View this project's final research report.

Journal Citations

Related Journal Citations

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • The reviewers had trouble seeing the connection between the qualitative and quantitative portions of the study. They suggested adding a diagram or a more detailed and specific description of the connection in prose. The researchers added a figure to the background section and provided a more concise abstract. They explained that they used the themes that emerged from focus groups to decide which variables to include in the development of the surveillance tool they used to study Medicare Current Beneficiary Survey data.
  • Reviewers noted that the discussion repeatedly referred to people “with and without disabilities,” implying that similar themes emerged for both groups. However, they wondered whether a larger qualitative study would have found differences between groups. The researchers said they hypothesized that different themes would emerge for people with and without disabilities but themes around healthcare experiences were consistent between the groups. The researchers were confident about their results because of the strong support for these themes among participants and lack of new themes raised during the process. They were also confident because the themes remained stable after participants were able to make corrections or clarify the themes in writing and in speaking about them.
  • Reviewers wondered why the researchers excluded people younger than age 65 from the quantitative portion of the study. The researchers responded that while their focus groups included people younger than 65, they did not include that age group in the quantitative analysis because of the limited number of Medicare beneficiaries under 65 and the high use of proxy respondents for that age group. The researchers also excluded this age group because large amounts of data were missing for those under 65.
  • Reviewers noted the small sample size for the qualitative portion of the study, especially given the inclusion of participants without disabilities and clinicians in focus groups, as well as participants with disabilities. The researchers said they included participants from the three different groups because these groups interact in the healthcare environment and could offer different perspectives on how to improve care for people with disabilities.

Conflict of Interest Disclosures

Project Information

Hillary Bogner, MD^
University of Pennsylvania
$1,580,956 *
10.25302/05.2020.AD.12114567
Mrs. A and Mr. B (People with Disabilities, Primary Care Provider Quality, and Disparities)

Key Dates

May 2013
March 2019
2013
2018

Study Registration Information

^Margaret Stineman, MD was the original principal investigator for this project.

Final Research Report

View this project's final research report.

Journal Articles

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Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: November 30, 2022