of Work: The purpose of this study is to develop protocols for performance testing that can be used in the clinical setting and to determine the feasibility of routine performance testing in the outpatient clinic setting. It will be examined whether this information can be used to identify those older persons at increased risk of future adverse outcomes whose risk status might not be appreciated using more conventional clinical assessment. Patients in both the Kansas City VA Medical Center and a local HMO are currently being administered performance tests when they are seen for routine clinical care. They will receive repeated assessments at all clinic visits to identify those with functional decline. Further follow-up and linkage to VA and HMO records are being used by HMO's to evaluate the ability of performance measures to predict a number of adverse outcomes. Preliminary data analyses have demonstrated that persons with poorer performance at baseline have higher mortality, greater medical expenditures, more hospitalizations, and higher use of emergency rooms. In comparing the performance measures to an assessment tool currently being used by HMO's to screen for persons at high risk of hospital utilization, it was found that the performance measures add predictive information that is independent of the established screening instrument. Further work will identify patients who have a decline in performance over time and evaluate whether this decline occurred in the absence of major medical events that cause catastrophic loss of functioning. Demonstrating that a proportion of persons with performance decline do so without major medical events provides evidence that the measures can be used to identify declining functioning that might be otherwise missed by the clinician.
