The two prognostic mortality indices, the PACE Prognostic Index (PPI) and the Walter Index, did not accurately discriminate between individuals at low and high risk of near-term mortality when applied to a PACE site population. The PPI, which was developed in a similar PACE population, showed no discrimination between risk groups at 1, 3, or 5 years. The Walter Index showed minimal discrimination at 3 years but none at 1 year. Recalibration of the PPI may be needed to improve its predictive ability for the current PACE population.

3. This result is most surprising for the PACE Prognostic Index (PPI), which was developed in a very similar patient population.

4. Temporal and geographic variation in this population, as well as increases in the overall mortality rate of PACE patients, may reduce the validity of the PPI index.

6. Scoring: Members were scored based on their medical assessment during 2004, using both the Walter Index and the PACE Prognostic Index.

8. The area under the ROC curve was 0.55 at 1 year and 0.52 and 3 years. Carey EC, Covinsky KE, Lui L-Y, et al. Prediction of mortality in community-living frail elderly people with long-term care needs. J Am Geriatr Soc. 2008;56(1):68-75. Walter LC, Brand RJ, Counsell SR, et al. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA. 2001;285(23):2987-2994. Low Risk Moderate Risk High Risk Very High Risk ACKNOWLEDGEMENTS The authors would like to thank Tracy Nettles, Lorraine Carsello and all the staff at the Mercy LIFE program for making this project possible. 1 2 3 4 5 Data from the original study