LEAD Panel Assessment

This page contains tables that summarize the LEAD Assessment Panel Data. The first table summarizes the data without grouping the rows by MedStar ID while the second table provides a summary of abuse determination for each unique MedStar ID.

Methods

LEAD panels were provided a presentation detailing the voting process and definitions for the various sub types of elder mistreatment prior to convening and then a total of 3 votes occurred per individual abuse case.

Initial Assessment

At each discussion, a research staff member presented a brief clinical description of each patient to LEAD panel members. Following this description, LEAD panel members were given further time to review the corresponding case materials. Members were then instructed to cast an initial ballot to document their assessment of the global presence of elder mistreatment (“Yes abuse”, “No abuse”, “Unable to determine”). After the first vote was completed, individuals reported to the group their assessment on the presence or absence of EM. If complete agreement was present among members (i.e., all members voting “Yes” or “No”), then consensus was reached and panel members would wait for the research staff member to present the next case, and the process would restart.

Secondary Assessment

If one or more panel members voted differently than the other members on the global presence of abuse, panel members were asked to discuss their interpretations of the clinical data presented to them. Members then were instructed to cast another vote using the method previously discussed for vote 1. After vote 2, determination of the LEAD panel for the presence or absence of elder mistreatment was made by a simple majority vote. For example, if at least 3 panel members (out of 5) indicated that no abuse was present at vote 2, then LEAD panel determination was classified as “No abuse” present for that case. If there was no majority, such as in the event that 2 members voted “Yes abuse”, 2 members voted “No abuse”, and 1 member voted “Unable to determine”, then that case was classified as “Unable to Determine”.

Post-DETECT Assessment

A research staff member would then present a previously redacted overall results from a Structured Social and Behavioral Evaluation (SSBE) of the participant. LEAD panel members were then instructed to cast a third vote. Following Vote 3, individuals were then asked to document the types of abuse present (“Physical”, “Psychological”, “Financial”, “Sexual”, and “Neglect”). This vote reflects the decision by the LEAD panel members after all relevant information is available to them. For each abuse type, the final classification (i.e., “Yes”, “No”, “Unable to Determine”) was made using an identical method to that described above for determining global abuse status after vote 2.

Summary Statistics for LEAD Panel Assessment Positive Votes

Initial MedStar Medic DETECT Tool Abuse Determination vs LEAD Panel Assessment Final Determination

The DETECT tool determination was counted as positive if the value of any of the detect tool variables was ‘Yes’ while the LEAD Panel Assessment was counted as positive if the final determination value was ‘Yes’ for any of the abuse types.

LEAD Panel Assessment
Detect Tool	positive	negative	Total
positive	6	19	25
negative	30	379	409
Total	36	398	434

Sensitivity	16.67 %
Specificity	95.23 %
Prevalence	8.29 %

Unique Medstar ID Summary

Assessment	Unique ID Count	Unique ID Proportion of Total
Initial assessment	798	1.00
Secondary assessment	135	0.17
Post-detect assessment	553	0.69

Final LEAD Panel Assessment Abuse Determination

The final abuse determination is the result of the majority vote of the secondary assessment (if one was done) or initial assessment (if a secondary assessment wasn’t done).

physical_abuse_det
LEAD Assessment physical abuse determination based on majority vote.
Variable	Category	N	Percent of N (95% CI)
physical_abuse_det	No	789	99.1 (98.2 - 99.6)
physical_abuse_det	Yes	7	0.9 (0.4 - 1.8)

sexual_abuse_det
LEAD Assessment sexual abuse determination based on majority vote.
Variable	Category	N	Percent of N (95% CI)
sexual_abuse_det	No	796	99.9 (99.1 - 100.0)
sexual_abuse_det	Yes	1	0.1 (0.0 - 0.9)

emotional_psycho_abuse_det
LEAD Assessment emotional/ psychological abuse determination based on majority vote.
Variable	Category	N	Percent of N (95% CI)
emotional_psycho_abuse_det	No	752	94.4 (92.5 - 95.8)
emotional_psycho_abuse_det	Yes	45	5.6 (4.2 - 7.5)

neglect_det
LEAD Assessment neglect determination based on majority vote.
Variable	Category	N	Percent of N (95% CI)
neglect_det	No	789	99.0 (98.0 - 99.5)
neglect_det	Yes	8	1.0 (0.5 - 2.0)

self_neglect_det
LEAD Assessment self-neglect determination based on majority vote.
Variable	Category	N	Percent of N (95% CI)
self_neglect_det	No	782	98.2 (97.0 - 99.0)
self_neglect_det	Yes	14	1.8 (1.0 - 3.0)

financial_exploitation_det
LEAD Assessment financial exploitation determination based on majority vote.
Variable	Category	N	Percent of N (95% CI)
financial_exploitation_det	No	785	98.5 (97.4 - 99.1)
financial_exploitation_det	Yes	12	1.5 (0.9 - 2.6)

abandonment_det
LEAD Assessment abandonment determination based on majority vote.
Variable	Category	N	Percent of N (95% CI)
abandonment_det	No	796	99.9 (99.1 - 100.0)
abandonment_det	Yes	1	0.1 (0.0 - 0.9)

abuse_any
There is a positive LEAD Panel Assessment abuse determination based on majority vote for any abuse type.
Variable	Category	N	Percent of N (95% CI)
abuse_any	No	726	91.3 (89.1 - 93.1)
abuse_any	Yes	69	8.7 (6.9 - 10.9)

LEAD Panel Assessment Determination Based on Majority Vote

physical_abuse_det
LEAD Assessment physical abuse determination based on majority vote.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
physical_abuse_det	No	Initial assessment	789	99.1 (98.2 - 99.6)
physical_abuse_det	Yes	Initial assessment	7	0.9 (0.4 - 1.8)
physical_abuse_det	No	Secondary assessment	128	94.8 (89.5 - 97.5)
physical_abuse_det	Yes	Secondary assessment	7	5.2 (2.5 - 10.5)
physical_abuse_det	No	Post-detect assessment	546	98.9 (97.6 - 99.5)
physical_abuse_det	Yes	Post-detect assessment	6	1.1 (0.5 - 2.4)

sexual_abuse_det
LEAD Assessment sexual abuse determination based on majority vote.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
sexual_abuse_det	No	Initial assessment	795	99.7 (99.0 - 99.9)
sexual_abuse_det	Yes	Initial assessment	2	0.3 (0.1 - 1.0)
sexual_abuse_det	No	Secondary assessment	134	99.3 (94.9 - 99.9)
sexual_abuse_det	Yes	Secondary assessment	1	0.7 (0.1 - 5.1)
sexual_abuse_det	No	Post-detect assessment	551	99.8 (98.7 - 100.0)
sexual_abuse_det	Yes	Post-detect assessment	1	0.2 (0.0 - 1.3)

emotional_psycho_abuse_det
LEAD Assessment emotional/ psychological abuse determination based on majority vote.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
emotional_psycho_abuse_det	No	Initial assessment	758	95.2 (93.5 - 96.5)
emotional_psycho_abuse_det	Yes	Initial assessment	38	4.8 (3.5 - 6.5)
emotional_psycho_abuse_det	No	Secondary assessment	101	74.8 (66.8 - 81.4)
emotional_psycho_abuse_det	Yes	Secondary assessment	34	25.2 (18.6 - 33.2)
emotional_psycho_abuse_det	No	Post-detect assessment	524	94.9 (92.7 - 96.5)
emotional_psycho_abuse_det	Yes	Post-detect assessment	28	5.1 (3.5 - 7.3)

neglect_det
LEAD Assessment neglect determination based on majority vote.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
neglect_det	No	Initial assessment	792	99.4 (98.5 - 99.7)
neglect_det	Yes	Initial assessment	5	0.6 (0.3 - 1.5)
neglect_det	No	Secondary assessment	127	94.1 (88.6 - 97.0)
neglect_det	Yes	Secondary assessment	8	5.9 (3.0 - 11.4)
neglect_det	No	Post-detect assessment	547	99.1 (97.8 - 99.6)
neglect_det	Yes	Post-detect assessment	5	0.9 (0.4 - 2.2)

self_neglect_det
LEAD Assessment self-neglect determination based on majority vote.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
self_neglect_det	No	Initial assessment	783	98.4 (97.2 - 99.1)
self_neglect_det	Yes	Initial assessment	13	1.6 (0.9 - 2.8)
self_neglect_det	No	Secondary assessment	123	91.1 (85.0 - 94.9)
self_neglect_det	Yes	Secondary assessment	12	8.9 (5.1 - 15.0)
self_neglect_det	No	Post-detect assessment	537	97.3 (95.5 - 98.4)
self_neglect_det	Yes	Post-detect assessment	15	2.7 (1.6 - 4.5)

financial_exploitation_det
LEAD Assessment financial exploitation determination based on majority vote.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
financial_exploitation_det	No	Initial assessment	788	98.9 (97.8 - 99.4)
financial_exploitation_det	Yes	Initial assessment	9	1.1 (0.6 - 2.2)
financial_exploitation_det	No	Secondary assessment	124	91.9 (85.9 - 95.4)
financial_exploitation_det	Yes	Secondary assessment	11	8.1 (4.6 - 14.1)
financial_exploitation_det	No	Post-detect assessment	544	98.6 (97.1 - 99.3)
financial_exploitation_det	Yes	Post-detect assessment	8	1.4 (0.7 - 2.9)

abandonment_det
LEAD Assessment abandonment determination based on majority vote.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
abandonment_det	No	Initial assessment	796	100.0 (NaN - NaN)
abandonment_det	Yes	Initial assessment	0	0.0 (NaN - NaN)
abandonment_det	No	Secondary assessment	134	99.3 (94.9 - 99.9)
abandonment_det	Yes	Secondary assessment	1	0.7 (0.1 - 5.1)
abandonment_det	No	Post-detect assessment	551	99.8 (98.7 - 100.0)
abandonment_det	Yes	Post-detect assessment	1	0.2 (0.0 - 1.3)

abuse_any
There is a positive LEAD Panel Assessment abuse determination based on majority vote for any abuse type.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
abuse_any	No	Initial assessment	735	92.7 (90.7 - 94.3)
abuse_any	Yes	Initial assessment	58	7.3 (5.7 - 9.3)
abuse_any	No	Secondary assessment	79	58.5 (50.0 - 66.6)
abuse_any	Yes	Secondary assessment	56	41.5 (33.4 - 50.0)
abuse_any	No	Post-detect assessment	505	91.5 (88.8 - 93.5)
abuse_any	Yes	Post-detect assessment	47	8.5 (6.5 - 11.2)

Any Positive Votes

For each assessment (initial, secondary, and post-DETECT), at least one LEAD panelist voted ‘Yes’ for each sub type of abuse.

physical_abuse_any
At least one LEAD panelist voted 'Yes' for physical abuse.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
physical_abuse_any	No	Initial assessment	775	97.4 (96.0 - 98.3)
physical_abuse_any	Yes	Initial assessment	21	2.6 (1.7 - 4.0)
physical_abuse_any	No	Secondary assessment	125	92.6 (86.7 - 96.0)
physical_abuse_any	Yes	Secondary assessment	10	7.4 (4.0 - 13.3)
physical_abuse_any	No	Post-detect assessment	542	98.2 (96.7 - 99.0)
physical_abuse_any	Yes	Post-detect assessment	10	1.8 (1.0 - 3.3)

sexual_abuse_any
At least one LEAD panelist voted 'Yes' for sexual abuse.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
sexual_abuse_any	No	Initial assessment	793	99.5 (98.7 - 99.8)
sexual_abuse_any	Yes	Initial assessment	4	0.5 (0.2 - 1.3)
sexual_abuse_any	No	Secondary assessment	133	98.5 (94.2 - 99.6)
sexual_abuse_any	Yes	Secondary assessment	2	1.5 (0.4 - 5.8)
sexual_abuse_any	No	Post-detect assessment	550	99.6 (98.6 - 99.9)
sexual_abuse_any	Yes	Post-detect assessment	2	0.4 (0.1 - 1.4)

emotional_psycho_abuse_any
At least one LEAD panelist voted 'Yes' for emotional/ psychological abuse.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
emotional_psycho_abuse_any	No	Initial assessment	720	90.5 (88.2 - 92.3)
emotional_psycho_abuse_any	Yes	Initial assessment	76	9.5 (7.7 - 11.8)
emotional_psycho_abuse_any	No	Secondary assessment	95	70.4 (62.1 - 77.5)
emotional_psycho_abuse_any	Yes	Secondary assessment	40	29.6 (22.5 - 37.9)
emotional_psycho_abuse_any	No	Post-detect assessment	516	93.5 (91.1 - 95.3)
emotional_psycho_abuse_any	Yes	Post-detect assessment	36	6.5 (4.7 - 8.9)

neglect_any
At least one LEAD panelist voted 'Yes' for neglect.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
neglect_any	No	Initial assessment	766	96.1 (94.5 - 97.3)
neglect_any	Yes	Initial assessment	31	3.9 (2.7 - 5.5)
neglect_any	No	Secondary assessment	120	88.9 (82.4 - 93.2)
neglect_any	Yes	Secondary assessment	15	11.1 (6.8 - 17.6)
neglect_any	No	Post-detect assessment	538	97.5 (95.8 - 98.5)
neglect_any	Yes	Post-detect assessment	14	2.5 (1.5 - 4.2)

self_neglect_any
At least one LEAD panelist voted 'Yes' for self-neglect.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
self_neglect_any	No	Initial assessment	763	95.9 (94.2 - 97.0)
self_neglect_any	Yes	Initial assessment	33	4.1 (3.0 - 5.8)
self_neglect_any	No	Secondary assessment	121	89.6 (83.2 - 93.8)
self_neglect_any	Yes	Secondary assessment	14	10.4 (6.2 - 16.8)
self_neglect_any	No	Post-detect assessment	537	97.3 (95.5 - 98.4)
self_neglect_any	Yes	Post-detect assessment	15	2.7 (1.6 - 4.5)

financial_exploitation_any
At least one LEAD panelist voted 'Yes' for financial exploitation.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
financial_exploitation_any	No	Initial assessment	762	95.6 (93.9 - 96.8)
financial_exploitation_any	Yes	Initial assessment	35	4.4 (3.2 - 6.1)
financial_exploitation_any	No	Secondary assessment	119	88.1 (81.5 - 92.6)
financial_exploitation_any	Yes	Secondary assessment	16	11.9 (7.4 - 18.5)
financial_exploitation_any	No	Post-detect assessment	540	97.8 (96.2 - 98.8)
financial_exploitation_any	Yes	Post-detect assessment	12	2.2 (1.2 - 3.8)

abandonment_any
At least one LEAD panelist voted 'Yes' for abandonment.
Variable	Category	Assessment Type	N	Percent of N (95% CI)
abandonment_any	No	Initial assessment	792	99.5 (98.7 - 99.8)
abandonment_any	Yes	Initial assessment	4	0.5 (0.2 - 1.3)
abandonment_any	No	Secondary assessment	134	99.3 (94.9 - 99.9)
abandonment_any	Yes	Secondary assessment	1	0.7 (0.1 - 5.1)
abandonment_any	No	Post-detect assessment	550	99.6 (98.6 - 99.9)
abandonment_any	Yes	Post-detect assessment	2	0.4 (0.1 - 1.4)

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