Predicting Mortality and Healthcare Utilization with a Single Question

University of Washington Seattle, Seattle, Washington, United States
Health Services Research (Impact Factor: 2.78). 08/2005; 40(4):1234-46. DOI: 10.1111/j.1475-6773.2005.00404.x
Source: PubMed


We compared single- and multi-item measures of general self-rated health (GSRH) to predict mortality and clinical events a large population of veteran patients.
We analyzed prospective cohort data collected from 21,732 patients as part of the Veterans Affairs Ambulatory Care Quality Improvement Project (ACQUIP), a randomized controlled trial investigating quality-of-care interventions.
We created an age-adjusted, logistic regression model for each predictor and outcome combination, and estimated the odds of events by response category of the GSRH question and compared the discriminative ability of the predictors by developing receiver operator characteristic curves and comparing the associated area under the curve (AUC)/c-statistic for the single- and multi-item measures.
All patients were sent a baseline assessment that included a multi-item measure of general health, the 36-item Medical Outcomes Study Short Form (SF-36), and an inventory of comorbid conditions. We compared the predictive and discriminative ability of the GSRH to the SF-36 physical component score (PCS), the mental component score (MCS), and the Seattle index of comorbidity (SIC). The GSRH is an item included in the SF-36, with the wording: "In general, would you say your health is: Excellent, Very Good, Good, Fair, Poor?"
The GSRH, PCS, and SIC had comparable AUC for predicting mortality (AUC 0.74, 0.73, and 0.73, respectively); hospitalization (AUC 0.63, 0.64, and 0.60, respectively); and high outpatient use (AUC 0.61, 0.61, and 0.60, respectively). The MCS had statistically poorer discriminatory performance for mortality and hospitalization than any other other predictors (p<.001).
The GSRH response categories can be used to stratify patients with varying risks for adverse outcomes. Patients reporting "poor" health are at significantly greater odds of dying or requiring health care resources compared with their peers. The GSRH, collectable at the point of care, is comparable with longer instruments.

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    • "Self-rated health is a health measure based on the response to the simple question, " How do you feel? " . Cumulative evidence suggests that self-rated health is a strong independent predictor for health outcomes such as morbidity and mortality [3],[4]. Further studies have shown that selfrated health status contains more important prognostic information than physician-assessed health status [5],[6]. "

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    • "Of interest are the associations between SRH and health outcomes at the individual level in late life. Poor self-rated health is associated with increased risk of stroke, disability, health care usage, and mortality (Ben-Ezra and Shmotkin, 2006; DeSalvo et al., 2005; Emmelin et al., 2003; Sargent-Cox et al., 2010a). Gender has been found to impact SRH ratings, though there is inconsistency within the literature as to the direction of the relationship , particularly with age (e.g. "
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    ABSTRACT: While it is clear that health behaviors are related to self-rated health (SRH), it is less clear if maintaining positive behaviors, or improving, can protect SRH over time. SRH trajectories were modeled in a large representative Australian sample (n=7485 at baseline), of three age cohorts (20-24, 40-44 and 60-64years at baseline; 1999, 2000 & 2001 respectively), over an 8year period. Change in smoking, alcohol consumption and physical activity on SRH trajectories were examined, controlling for demographic, physical and mental health factors. SRH became poorer over time across the sample. Being a non-smoker was associated with more positive SRH levels across all groups. Maintaining or increasing moderate physical activity was associated with less decline in SRH. Findings highlight the benefits of positive health behaviors, particularly performing regular physical activity over time, for reducing the risk of subjective health becoming poorer across the adult life course.
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    • "Individuals’ subjective satisfaction with their lives may be referred to as subjective quality of life, although it needs to be recognized that all quality of life measures are subjective to some extent and that there are no universally accepted definitions of such terms [5,6]. Both health-related quality of life and subjective quality of life have been found to be strongly predictive of more objective indices of health status, including chronic disease and mortality, as well as health service utilization, hence their utility as measures of disease burden [7-9]. "
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