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Adding Functional Ability Measures to a Mortality Algorithm to Support Palliative Care Eligibility Decisions
Elizabeth A Luth1,2, Carlin Brickner3, Harivony Rakotoarivelo3
1Department of Family and Community Medicine, Robert Wood Johnson Medical School.
Research in Gerontological Nursing
|June 9, 2025
Summary
Functional ability measures like activities of daily living (ADL) support and skilled nursing predict mortality. Physical therapy/occupational therapy (PT/OT) services were linked to lower mortality, aiding palliative care referrals.
Area of Science:
- Gerontology
- Health Services Research
- Palliative Care
Background:
- Identifying individuals for palliative care is crucial for improving quality of life.
- Administrative claims data offer a valuable resource for assessing patient functional status.
- Functional ability measures can serve as indicators for serious illness and mortality risk.
Purpose of the Study:
- To establish functional ability measures from administrative claims data.
- To identify patients eligible for palliative care.
- To analyze the relationship between functional ability and mortality.
Main Methods:
- Retrospective cohort analysis of Medicare Advantage claims data (July 2022-June 2023).
- Inclusion of 6,625 enrollees.
- Logistic regression to assess associations between functional ability measures (ADL, feeding/respiratory support, PT/OT, skilled nursing) and mortality.
Main Results:
- 186 (4.6%) deaths occurred during the study period.
- Physical therapy/occupational therapy (PT/OT) services were associated with decreased mortality (aOR=0.74, 95% CI [0.65, 0.85]).
- Activities of daily living (ADL) support, skilled nursing, and pain management were linked to increased mortality.
Conclusions:
- Functional ability measures derived from claims data can predict mortality risk.
- Observing PT/OT, ADL support, and skilled nursing status may facilitate timely palliative care referrals.
- These findings support the use of administrative data for proactive patient management in serious illness.
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