Clinical characteristics and Omaha System risk factors in the cohort by cluster
| Temporal pattern . | Cluster 1: no risk factors . | Cluster 2: steeply decreased . | Cluster 3: decreased . | Cluster 4: steeply increased . | Cluster 5: decreased and rebound increased . | Cluster 6: steadily present . |
|---|---|---|---|---|---|---|
| Frequency [n, (%)] | 5413 (7.38%) | 35 193 (48%) | 14 537 (19.8%) | 5608 (7.65%) | 7747 (10.56%) | 4852 (6.61%) |
| Hospitalizations and ED visits [n, (%)] | 394 (7.28%) | 3033 (8.62%) | 1854 (12.8%) | 1021 (18.2%) | 1258 (16.2%) | 667 (13.7%) |
| 1. Socio-demographic factors | ||||||
| Age, years [mean, (SD)] | 79.0 (12.0) | 79.2 (11.5) | 79.3 (11.5) | 78.1 (12.1) | 79.0 (11.7) | 77.4 (12.0) |
| Female gender | 3398 (62.8%) | 22 821 (64.8%) | 9481 (65.2%) | 3498 (62.4%) | 4985 (64.3%) | 2976 (61.3%) |
| Ethnicity [n, (%)] | ||||||
| Non-Hispanic White patients | 3199 (59.1%) | 22 414 (63.7%) | 9406 (64.7%) | 3526 (62.9%) | 4896 (63.2%) | 3011 (62.1%) |
| Non-Hispanic Black patients | 1092 (20.2%) | 5842 (16.6%) | 2428 (16.7%) | 999 (17.8%) | 1357 (17.5%) | 888 (18.3%) |
| Hispanic patients | 746 (13.8%) | 4687 (13.3%) | 1902 (13.1%) | 754 (13.5%) | 1049 (13.5%) | 659 (13.6%) |
| Other | 376 (6.95%) | 2250 (6.4%) | 801 (5.51%) | 329 (5.87%) | 445 (5.74%) | 294 (6.1%) |
| Type of insurance [n, (%)] | ||||||
| Dual eligibility | 332 (6.13%) | 2081 (5.91%) | 924 (6.36%) | 325 (5.8%) | 497 (6.42%) | 310 (6.39%) |
| Medicare/Medicaid Fee-for-service only | 4957 (91.6%) | 32 228 (91.6%) | 13 266 (91.3%) | 5111 (91.14%) | 7071 (91.27%) | 4388 (90.44%) |
| Any managed care only | 25 (0.5%) | 192 (0.55%) | 78 (0.54%) | 37 (0.66%) | 42 (0.54%) | 41 (0.85%) |
| Other (eg, private) | 102 (1.88%) | 692 (1.97%) | 269 (1.85%) | 135 (2.41%) | 137 (1.77%) | 113 (2.33%) |
| Living arrangements | ||||||
| Patient lives alone | 1897 (35.0%) | 13 958 (39.7%) | 5619 (38.7%) | 2023 (36.1%) | 2895 (37.4%) | 1973 (40.7%) |
| 2. Comorbidity [mean, (SD)] | ||||||
| Number of Comorbiditiesa | 1.7 (2.5) | 1.58 (2.5) | 1.75 (2.6) | 1.78 (2.56) | 1.84 (2.6) | 1.52 (2.5) |
| Severity of Comorbiditiesb | 3.29 (5.12) | 2.9 (4.9) | 3.3 (5.1) | 3.4 (5.1) | 3.5 (5.3) | 2.8 (4.8) |
| 3. ADLs/IADLs [mean, (SD)] | ||||||
| ADL Neededc | 7.99 (1.59) | 8.06 (1.45) | 8.17 (1.37) | 8.01 (1.55) | 8.15 (1.38) | 7.76 (1.77) |
| ADL Severityd | 15.5 (7.06) | 15.3 (6.40) | 16.0 (6.67) | 15.3 (6.73) | 16.0 (6.76) | 14.1 (6.34) |
| 4. Risk factor documented in clinical notes (Omaha System problem) [mean, (SD)] | ||||||
| Total number of risk factors | – | 3.36 (1.93) | 3.89 (2.13) | 2.97 (2.04) | 3.68 (2.14) | 3.14 (1.67) |
| 5. Domains of risk factors documented in clinical notes (Omaha System Domain) [n, (%)] | ||||||
| Environmental Domain | – | 3273 (9.30%) | 1979 (13.6%) | 1048 (18.7%) | 1312 (16.9%) | 694 (14.3%) |
| Psychosocial Domain | – | 16 786 (47.7%) | 7990 (55.0%) | 2383 (42.5%) | 4003 (51.7%) | 2172 (44.8%) |
| Physiological Domain | – | 33 262 (94.5%) | 13 905 (95.7%) | 4971 (88.6%) | 7309 (94.3%) | 4619 (95.2%) |
| Health-related behaviors Domain | – | 7168 (20.4%) | 3699 (25.4%) | 1129 (20.1%) | 1855 (23.9%) | 992 (20.4%) |
| Temporal pattern . | Cluster 1: no risk factors . | Cluster 2: steeply decreased . | Cluster 3: decreased . | Cluster 4: steeply increased . | Cluster 5: decreased and rebound increased . | Cluster 6: steadily present . |
|---|---|---|---|---|---|---|
| Frequency [n, (%)] | 5413 (7.38%) | 35 193 (48%) | 14 537 (19.8%) | 5608 (7.65%) | 7747 (10.56%) | 4852 (6.61%) |
| Hospitalizations and ED visits [n, (%)] | 394 (7.28%) | 3033 (8.62%) | 1854 (12.8%) | 1021 (18.2%) | 1258 (16.2%) | 667 (13.7%) |
| 1. Socio-demographic factors | ||||||
| Age, years [mean, (SD)] | 79.0 (12.0) | 79.2 (11.5) | 79.3 (11.5) | 78.1 (12.1) | 79.0 (11.7) | 77.4 (12.0) |
| Female gender | 3398 (62.8%) | 22 821 (64.8%) | 9481 (65.2%) | 3498 (62.4%) | 4985 (64.3%) | 2976 (61.3%) |
| Ethnicity [n, (%)] | ||||||
| Non-Hispanic White patients | 3199 (59.1%) | 22 414 (63.7%) | 9406 (64.7%) | 3526 (62.9%) | 4896 (63.2%) | 3011 (62.1%) |
| Non-Hispanic Black patients | 1092 (20.2%) | 5842 (16.6%) | 2428 (16.7%) | 999 (17.8%) | 1357 (17.5%) | 888 (18.3%) |
| Hispanic patients | 746 (13.8%) | 4687 (13.3%) | 1902 (13.1%) | 754 (13.5%) | 1049 (13.5%) | 659 (13.6%) |
| Other | 376 (6.95%) | 2250 (6.4%) | 801 (5.51%) | 329 (5.87%) | 445 (5.74%) | 294 (6.1%) |
| Type of insurance [n, (%)] | ||||||
| Dual eligibility | 332 (6.13%) | 2081 (5.91%) | 924 (6.36%) | 325 (5.8%) | 497 (6.42%) | 310 (6.39%) |
| Medicare/Medicaid Fee-for-service only | 4957 (91.6%) | 32 228 (91.6%) | 13 266 (91.3%) | 5111 (91.14%) | 7071 (91.27%) | 4388 (90.44%) |
| Any managed care only | 25 (0.5%) | 192 (0.55%) | 78 (0.54%) | 37 (0.66%) | 42 (0.54%) | 41 (0.85%) |
| Other (eg, private) | 102 (1.88%) | 692 (1.97%) | 269 (1.85%) | 135 (2.41%) | 137 (1.77%) | 113 (2.33%) |
| Living arrangements | ||||||
| Patient lives alone | 1897 (35.0%) | 13 958 (39.7%) | 5619 (38.7%) | 2023 (36.1%) | 2895 (37.4%) | 1973 (40.7%) |
| 2. Comorbidity [mean, (SD)] | ||||||
| Number of Comorbiditiesa | 1.7 (2.5) | 1.58 (2.5) | 1.75 (2.6) | 1.78 (2.56) | 1.84 (2.6) | 1.52 (2.5) |
| Severity of Comorbiditiesb | 3.29 (5.12) | 2.9 (4.9) | 3.3 (5.1) | 3.4 (5.1) | 3.5 (5.3) | 2.8 (4.8) |
| 3. ADLs/IADLs [mean, (SD)] | ||||||
| ADL Neededc | 7.99 (1.59) | 8.06 (1.45) | 8.17 (1.37) | 8.01 (1.55) | 8.15 (1.38) | 7.76 (1.77) |
| ADL Severityd | 15.5 (7.06) | 15.3 (6.40) | 16.0 (6.67) | 15.3 (6.73) | 16.0 (6.76) | 14.1 (6.34) |
| 4. Risk factor documented in clinical notes (Omaha System problem) [mean, (SD)] | ||||||
| Total number of risk factors | – | 3.36 (1.93) | 3.89 (2.13) | 2.97 (2.04) | 3.68 (2.14) | 3.14 (1.67) |
| 5. Domains of risk factors documented in clinical notes (Omaha System Domain) [n, (%)] | ||||||
| Environmental Domain | – | 3273 (9.30%) | 1979 (13.6%) | 1048 (18.7%) | 1312 (16.9%) | 694 (14.3%) |
| Psychosocial Domain | – | 16 786 (47.7%) | 7990 (55.0%) | 2383 (42.5%) | 4003 (51.7%) | 2172 (44.8%) |
| Physiological Domain | – | 33 262 (94.5%) | 13 905 (95.7%) | 4971 (88.6%) | 7309 (94.3%) | 4619 (95.2%) |
| Health-related behaviors Domain | – | 7168 (20.4%) | 3699 (25.4%) | 1129 (20.1%) | 1855 (23.9%) | 992 (20.4%) |
Note: Using the analysis of variance (ANOVA) test, clinical characteristics between clusters were compared, and variables with P-values <.05 were listed in the table.
“Number of Comorbidities” which was defined as the summed binary ASPE Diagnosis indicators created using the OASIS Diagnosis items (eg, cancer, cardiac disease, stroke).38
“Severity of Comorbidities” was calculated by totaling the response categories of the severity level in comorbidity items (total ranged from 0 to 24).
“ADL Needed” which was defined as the summed binary ADL/IADL items (ranging from 0 to 9) derived from ADL items such as grooming, dressing upper and lower, bathing, toileting, transferring, ambulating, and eating, as well as IADL items such as meal preparation. Binary indicator 0 was given if response 0 was given (no issue); otherwise, 1 was given (moderate or significant issue).
“ADLs Severity” was calculated by totaling the response categories of the dependency level in ADL/IADL items (total ranged from 0 to 38).
Clinical characteristics and Omaha System risk factors in the cohort by cluster
| Temporal pattern . | Cluster 1: no risk factors . | Cluster 2: steeply decreased . | Cluster 3: decreased . | Cluster 4: steeply increased . | Cluster 5: decreased and rebound increased . | Cluster 6: steadily present . |
|---|---|---|---|---|---|---|
| Frequency [n, (%)] | 5413 (7.38%) | 35 193 (48%) | 14 537 (19.8%) | 5608 (7.65%) | 7747 (10.56%) | 4852 (6.61%) |
| Hospitalizations and ED visits [n, (%)] | 394 (7.28%) | 3033 (8.62%) | 1854 (12.8%) | 1021 (18.2%) | 1258 (16.2%) | 667 (13.7%) |
| 1. Socio-demographic factors | ||||||
| Age, years [mean, (SD)] | 79.0 (12.0) | 79.2 (11.5) | 79.3 (11.5) | 78.1 (12.1) | 79.0 (11.7) | 77.4 (12.0) |
| Female gender | 3398 (62.8%) | 22 821 (64.8%) | 9481 (65.2%) | 3498 (62.4%) | 4985 (64.3%) | 2976 (61.3%) |
| Ethnicity [n, (%)] | ||||||
| Non-Hispanic White patients | 3199 (59.1%) | 22 414 (63.7%) | 9406 (64.7%) | 3526 (62.9%) | 4896 (63.2%) | 3011 (62.1%) |
| Non-Hispanic Black patients | 1092 (20.2%) | 5842 (16.6%) | 2428 (16.7%) | 999 (17.8%) | 1357 (17.5%) | 888 (18.3%) |
| Hispanic patients | 746 (13.8%) | 4687 (13.3%) | 1902 (13.1%) | 754 (13.5%) | 1049 (13.5%) | 659 (13.6%) |
| Other | 376 (6.95%) | 2250 (6.4%) | 801 (5.51%) | 329 (5.87%) | 445 (5.74%) | 294 (6.1%) |
| Type of insurance [n, (%)] | ||||||
| Dual eligibility | 332 (6.13%) | 2081 (5.91%) | 924 (6.36%) | 325 (5.8%) | 497 (6.42%) | 310 (6.39%) |
| Medicare/Medicaid Fee-for-service only | 4957 (91.6%) | 32 228 (91.6%) | 13 266 (91.3%) | 5111 (91.14%) | 7071 (91.27%) | 4388 (90.44%) |
| Any managed care only | 25 (0.5%) | 192 (0.55%) | 78 (0.54%) | 37 (0.66%) | 42 (0.54%) | 41 (0.85%) |
| Other (eg, private) | 102 (1.88%) | 692 (1.97%) | 269 (1.85%) | 135 (2.41%) | 137 (1.77%) | 113 (2.33%) |
| Living arrangements | ||||||
| Patient lives alone | 1897 (35.0%) | 13 958 (39.7%) | 5619 (38.7%) | 2023 (36.1%) | 2895 (37.4%) | 1973 (40.7%) |
| 2. Comorbidity [mean, (SD)] | ||||||
| Number of Comorbiditiesa | 1.7 (2.5) | 1.58 (2.5) | 1.75 (2.6) | 1.78 (2.56) | 1.84 (2.6) | 1.52 (2.5) |
| Severity of Comorbiditiesb | 3.29 (5.12) | 2.9 (4.9) | 3.3 (5.1) | 3.4 (5.1) | 3.5 (5.3) | 2.8 (4.8) |
| 3. ADLs/IADLs [mean, (SD)] | ||||||
| ADL Neededc | 7.99 (1.59) | 8.06 (1.45) | 8.17 (1.37) | 8.01 (1.55) | 8.15 (1.38) | 7.76 (1.77) |
| ADL Severityd | 15.5 (7.06) | 15.3 (6.40) | 16.0 (6.67) | 15.3 (6.73) | 16.0 (6.76) | 14.1 (6.34) |
| 4. Risk factor documented in clinical notes (Omaha System problem) [mean, (SD)] | ||||||
| Total number of risk factors | – | 3.36 (1.93) | 3.89 (2.13) | 2.97 (2.04) | 3.68 (2.14) | 3.14 (1.67) |
| 5. Domains of risk factors documented in clinical notes (Omaha System Domain) [n, (%)] | ||||||
| Environmental Domain | – | 3273 (9.30%) | 1979 (13.6%) | 1048 (18.7%) | 1312 (16.9%) | 694 (14.3%) |
| Psychosocial Domain | – | 16 786 (47.7%) | 7990 (55.0%) | 2383 (42.5%) | 4003 (51.7%) | 2172 (44.8%) |
| Physiological Domain | – | 33 262 (94.5%) | 13 905 (95.7%) | 4971 (88.6%) | 7309 (94.3%) | 4619 (95.2%) |
| Health-related behaviors Domain | – | 7168 (20.4%) | 3699 (25.4%) | 1129 (20.1%) | 1855 (23.9%) | 992 (20.4%) |
| Temporal pattern . | Cluster 1: no risk factors . | Cluster 2: steeply decreased . | Cluster 3: decreased . | Cluster 4: steeply increased . | Cluster 5: decreased and rebound increased . | Cluster 6: steadily present . |
|---|---|---|---|---|---|---|
| Frequency [n, (%)] | 5413 (7.38%) | 35 193 (48%) | 14 537 (19.8%) | 5608 (7.65%) | 7747 (10.56%) | 4852 (6.61%) |
| Hospitalizations and ED visits [n, (%)] | 394 (7.28%) | 3033 (8.62%) | 1854 (12.8%) | 1021 (18.2%) | 1258 (16.2%) | 667 (13.7%) |
| 1. Socio-demographic factors | ||||||
| Age, years [mean, (SD)] | 79.0 (12.0) | 79.2 (11.5) | 79.3 (11.5) | 78.1 (12.1) | 79.0 (11.7) | 77.4 (12.0) |
| Female gender | 3398 (62.8%) | 22 821 (64.8%) | 9481 (65.2%) | 3498 (62.4%) | 4985 (64.3%) | 2976 (61.3%) |
| Ethnicity [n, (%)] | ||||||
| Non-Hispanic White patients | 3199 (59.1%) | 22 414 (63.7%) | 9406 (64.7%) | 3526 (62.9%) | 4896 (63.2%) | 3011 (62.1%) |
| Non-Hispanic Black patients | 1092 (20.2%) | 5842 (16.6%) | 2428 (16.7%) | 999 (17.8%) | 1357 (17.5%) | 888 (18.3%) |
| Hispanic patients | 746 (13.8%) | 4687 (13.3%) | 1902 (13.1%) | 754 (13.5%) | 1049 (13.5%) | 659 (13.6%) |
| Other | 376 (6.95%) | 2250 (6.4%) | 801 (5.51%) | 329 (5.87%) | 445 (5.74%) | 294 (6.1%) |
| Type of insurance [n, (%)] | ||||||
| Dual eligibility | 332 (6.13%) | 2081 (5.91%) | 924 (6.36%) | 325 (5.8%) | 497 (6.42%) | 310 (6.39%) |
| Medicare/Medicaid Fee-for-service only | 4957 (91.6%) | 32 228 (91.6%) | 13 266 (91.3%) | 5111 (91.14%) | 7071 (91.27%) | 4388 (90.44%) |
| Any managed care only | 25 (0.5%) | 192 (0.55%) | 78 (0.54%) | 37 (0.66%) | 42 (0.54%) | 41 (0.85%) |
| Other (eg, private) | 102 (1.88%) | 692 (1.97%) | 269 (1.85%) | 135 (2.41%) | 137 (1.77%) | 113 (2.33%) |
| Living arrangements | ||||||
| Patient lives alone | 1897 (35.0%) | 13 958 (39.7%) | 5619 (38.7%) | 2023 (36.1%) | 2895 (37.4%) | 1973 (40.7%) |
| 2. Comorbidity [mean, (SD)] | ||||||
| Number of Comorbiditiesa | 1.7 (2.5) | 1.58 (2.5) | 1.75 (2.6) | 1.78 (2.56) | 1.84 (2.6) | 1.52 (2.5) |
| Severity of Comorbiditiesb | 3.29 (5.12) | 2.9 (4.9) | 3.3 (5.1) | 3.4 (5.1) | 3.5 (5.3) | 2.8 (4.8) |
| 3. ADLs/IADLs [mean, (SD)] | ||||||
| ADL Neededc | 7.99 (1.59) | 8.06 (1.45) | 8.17 (1.37) | 8.01 (1.55) | 8.15 (1.38) | 7.76 (1.77) |
| ADL Severityd | 15.5 (7.06) | 15.3 (6.40) | 16.0 (6.67) | 15.3 (6.73) | 16.0 (6.76) | 14.1 (6.34) |
| 4. Risk factor documented in clinical notes (Omaha System problem) [mean, (SD)] | ||||||
| Total number of risk factors | – | 3.36 (1.93) | 3.89 (2.13) | 2.97 (2.04) | 3.68 (2.14) | 3.14 (1.67) |
| 5. Domains of risk factors documented in clinical notes (Omaha System Domain) [n, (%)] | ||||||
| Environmental Domain | – | 3273 (9.30%) | 1979 (13.6%) | 1048 (18.7%) | 1312 (16.9%) | 694 (14.3%) |
| Psychosocial Domain | – | 16 786 (47.7%) | 7990 (55.0%) | 2383 (42.5%) | 4003 (51.7%) | 2172 (44.8%) |
| Physiological Domain | – | 33 262 (94.5%) | 13 905 (95.7%) | 4971 (88.6%) | 7309 (94.3%) | 4619 (95.2%) |
| Health-related behaviors Domain | – | 7168 (20.4%) | 3699 (25.4%) | 1129 (20.1%) | 1855 (23.9%) | 992 (20.4%) |
Note: Using the analysis of variance (ANOVA) test, clinical characteristics between clusters were compared, and variables with P-values <.05 were listed in the table.
“Number of Comorbidities” which was defined as the summed binary ASPE Diagnosis indicators created using the OASIS Diagnosis items (eg, cancer, cardiac disease, stroke).38
“Severity of Comorbidities” was calculated by totaling the response categories of the severity level in comorbidity items (total ranged from 0 to 24).
“ADL Needed” which was defined as the summed binary ADL/IADL items (ranging from 0 to 9) derived from ADL items such as grooming, dressing upper and lower, bathing, toileting, transferring, ambulating, and eating, as well as IADL items such as meal preparation. Binary indicator 0 was given if response 0 was given (no issue); otherwise, 1 was given (moderate or significant issue).
“ADLs Severity” was calculated by totaling the response categories of the dependency level in ADL/IADL items (total ranged from 0 to 38).
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