SEEK - Identifying Frail Elderly

SEEK allows organizations to identify frail or imminently (within 12 months) frail Medicare-age members. The SEEK survey system includes two products – a Health Status Questionnaire and the Frailty Wheel. The Center for Health Research (CHR) provides various types of support, including survey mailing, data collection, and a customized database.

Why identify frailty?

Frailty is defined as “a high probability of dependency on others for daily care within 12 months.” Identifying frail members or those soon to become frail can help a health care organization target delivery of health care services and provide better care to those who need it the most. Identifying frail members can provide potential cost savings and help predict future needed resources. Frail members have a higher mortality rate and prevalence of other geriatric problems such as depression and severely impaired memory, falls, and daily activity impairments.

About the Program

Once a month CHR mails out a survey cover letter (click here for a sample) and questionnaire to those members identified from a data file. If the questionnaire is not returned, CHR will send out a reminder postcard and after three months, if the questionnaire is not returned a second questionnaire is sent.

CHR processes the data reported on the surveys, determines and evaluates sample size, computes risk scores, prepares response reports, and performs other related screening services. CHR analyzes the data from the returned forms to determine the risk score for probability of frailty and flags persons whose score is over 0.5. CHR sends all respondent data to the purchaser weekly through the secure Web data transfer site. CHR also provides a 1-800 line for members to phone project staff to ask specific questions about the survey or for reporting refusals or recent deaths.

Data Results Processing Program

The menu-driven program loads new data, prints person summaries, and marks printed material for distribution management. An individual summary report can be printed, copied, and distributed throughout the purchaser’s organization. The program comes with a detailed instruction guide.

Privacy and Confidentiality

CHR adheres to strict confidentiality standards it receives from the purchaser. The entire data transfer process is located on a secure transfer website that meets government confidentiality standards.

Contracts

Contracts specify the partnership between CHR and your organization and include terms such as the time-frame for which services are required and the number of anticipated survey participants. Contracts may be terminated by either party (CHR or purchaser) with 30 days’ notice. Please contact CHR for more information.

History

The SEEK program has been in existence and the Health Status Questionnaire in use for over a dozen years. CHR has surveyed over 550,000 persons nationwide to date. Data exchanges use a secure Web transfer site.

SEEK grew out of two research projects at the Center for Health Research in Portland, Oregon. The first is the Social HMO Medicare demonstration project (operating since 1985). The second was a study on the effects of antihypertensive medications on rates of depression and functioning among the elderly, funded by the National Institute on Aging. Eventually, the CHR was funded by the Garfield Memorial Fund to use the extensive home and community-based long-term care resources of the Social HMO databases to build the prediction model that eventually became SEEK (Screen Every Elder in Kaiser).

SEEK questionnaires have been used in every region of Kaiser Permanente, several U.S. Air Force bases, and in a number of federally funded research projects outside of Kaiser.

Research results have been shared at Congressional hearings, Institute of Medicine, HMO Research Network, National Alzheimer’s Association, national scientific meetings (AAHP, AHSR, GSA, ASA, APHA), peer-reviewed journals, and broadly within Kaiser Permanente. The SEEK Health Status Questionnaire and classification model are now the standard for all Kaiser Permanente regions.

Products

Tools to identify at-risk medicare-aged persons and stay ahead of the gray wave

Frailty Wheel

Health Status Questionnaire

 

Presentations

These presentations about population-based care, the SEEK services, and research findings are provided as an additional overview. The presentations may give you ideas for implementing SEEK services in your organization.


SEEK Presentation

Frailty Wheel presentation

Publications

Brody, Kathleen K., Johnson, Richard E., Ried, L. Douglas, Carder, Paula C. & Perrin, Nancy A Comparison of Two Methods for Identifying Frail Medicare-Aged Persons. Journal of the American Geriatrics Society 50 (3), 562-569. doi: 10.1046/j.1532-5415.2002.50127.x PubMed

Brody, KK, Johnson, RE, Douglas Ried, L Evaluation of a self-report screening instrument to predict frailty outcomes in aging populations Gerontologist 1997 37: 182-191 PubMed

Brody KK, Maslow K, Perrin NA, Crooks V, DellaPenna R, Kuang D. Usefulness of a single item in a mail survey to identify persons with possible dementia: A new population-based method for finding high-risk elders. Journal of Disease Management 2005; 8(2):59-72. PMID: 15815155 PubMed

Palsbo, Susan E., Mark C. Hornbrook, Kathleen Brody, and Nancy Perrin, “Using Diagnoses to Identify Adults with Disabilities.” Managed Care Quarterly, Vol 13, No 1, Winter, 2005, pp 6-12. PubMed

Brody KK, Perrin NA, Dellapenna R. Advanced illness index: Predictive modeling to stratify elders using self-report data. Palliat Med. 2006 Dec;9(6):1310-9. PMID: 17187539 PubMed