Importance of Functional Measures in Predicting Mortality Among Older Hospitalized Patients

Abstract

RISK ADJUSTMENT recently has acquired increasing importance for medical effectiveness and health policy evaluations. For evaluating medical effectiveness, meaningful comparison of outcomes between treatment groups requires controlling for patients' baseline risk.¹ For health policy evaluation, risk-adjusted outcome measures are being scrutinized by organizations, including government agencies, managed care companies, and consumer groups.² Given the current importance of these risk adjustment indices, examination of their content and validity is crucial. Burden of illness indices, defined as measures incorporating acute and chronic health and comorbidity, have been the primary means of health risk adjustment. In the evaluation of older persons, lack of inclusion of functional status has been a major limitation of these indices. Functional status—defined as everyday behaviors necessary to maintain daily life (eg, activities of daily living [ADLs]) and encompassing areas of physical, cognitive, and social functioning¹—is of key importance to health outcomes of the elderly.