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To the Editor: Dr Walter and colleagues¹ derived a prognostic index for 1-year mortality in older adults after hospitalization. The authors indicate that their instrument may have utility in the measurement of risk assessment as various institutions or caregivers are compared during quality measurement activities. In their Editorial, Drs Redelmeier and Lustig offer some constructive criticism and doubts.² However, neither Walter et al nor Redelmeier and Lustig discussed whether such an instrument might be used to mitigate malpractice claims for wrongful death in frail elderly persons at high risk for death, regardless of the quality of care they received.

Litigation for malpractice and wrongful death currently detracts from the nursing home industry's ability to improve on quality, and also threatens ongoing care for this most vulnerable population. The threat of malpractice no longer serves well as a fear factor to motivate better practices. Instead, the rising cost of liability insurance . . . [Full Text of this Article]

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RELATED ARTICLE

Development and Validation of a Prognostic Index for 1-Year Mortality in Older Adults After Hospitalization
Louise C. Walter, Richard J. Brand, Steven R. Counsell, Robert M. Palmer, C. Seth Landefeld, Richard H. Fortinsky, and Kenneth E. Covinsky
JAMA. 2001;285(23):2987-2994.
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