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Predictive validity of the Pra instrument among older recipients of managed care
J T Pacala1, C Boult, R L Reed
1Department of Family Practice and Community Health, University of Minnesota, Minneapolis 55414-3034, USA.
Objective:
To determine the validity of the Pra instrument in predicting the use of health-related services by older enrollees in a managed care plan.
Design:
Cohort study. At baseline, a survey was administered by mail. Responses were entered into the Pra formula to estimate each person's probability of using health-related services heavily in the future. The subjects' use of services during the following year was monitored through claims submitted to their managed care organization.
Setting:
Urban and suburban areas of Southern California.
Participants:
Persons aged 65 years and older enrolled in a Medicare risk health plan (n = 6802).
Measurements:
Baseline data included demographic, health-related, social, functional, and previous-use-of-service characteristics. Follow-up data included the use of and claims for payment for inpatient hospital care, emergency room services, nursing home services, home care, ambulance services, outpatient surgery, and durable medical equipment.
Results:
High-risk subjects (highest quartile of Pra values) incurred hospital admissions and claims that were 2.5 and 2.7 times greater than those of low-risk subjects (lower three quartiles).
Conclusions:
The Pra formula is recommended for screening older adults enrolled in managed care organizations (as well as for screening those in the fee-for-service environment). It identifies older people who may benefit from interventions designed to avert health crises and the need for expensive care.