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Updated: Nov 5, 2025

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Derivation and Validation of a Predictive Algorithm for Long-Term Care Admission or Death.

Caroline Madrigal1, Christopher W Halladay1, Kevin McConeghy1

  • 1Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, RI, USA; Brown School of Public Health, Providence, RI, USA.

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|May 13, 2021
PubMed
Summary

A new predictive algorithm, "Choose Home," identifies older veterans at high risk for long-term care or death. This tool aids clinicians in proactive care coordination to help veterans remain in their communities longer.

Keywords:
Long-term careVAhome-based primary carepredictive algorithmveterans

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Area of Science:

  • Gerontology
  • Health Services Research
  • Predictive Analytics

Background:

  • Older veterans prefer aging in place within their homes and communities.
  • Access to home- and community-based services (HCBS) is crucial but often inconsistently organized or delayed for veterans.
  • Early identification of veterans at high risk for long-term care placement or mortality is needed.

Purpose of the Study:

  • To develop and validate a predictive algorithm to identify veterans at high risk for long-term institutionalization or death.
  • To provide clinicians with a tool for proactive clinical decision-making and care coordination.

Main Methods:

  • A retrospective observational cohort analysis was conducted using two large cohorts (Derivation: 4.6 million; Confirmation: 4.7 million) of Veterans Health Administration (VHA) users.
  • 148 predictor variables (demographics, comorbidities, utilization) were selected via logistic regression.
  • The algorithm predicted placement in long-term care (>90 days) or death within two years.

Main Results:

  • The algorithm demonstrated good discrimination, with areas under the receiver operating characteristic curves of 0.80 in both the Derivation and Confirmation cohorts.
  • Veterans in the study were predominantly male (over 92%) and older (mean age ~61.6 years) with a high prevalence of comorbid conditions.

Conclusions:

  • The validated "Choose Home" algorithm effectively identifies veterans at high risk for long-term institutionalization or death.
  • This predictive tool can inform clinical decision-making and care coordination, potentially enabling targeted interventions to support aging in place.
  • The study lays the foundation for future research on optimizing HCBS delivery for high-risk older adults.