Development of a Prognostic Model for Six-Month Mortality in Older Adults With Declining Health

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• 作者：Paul K.J. Han ; MD ; MA ; MPH^a ; ^hanp@mmc.org ; Minjung Lee ; PhD^b ; Bryce B. Reeve ; PhD^b ; Angela B. Mariotto ; PhD^b ; Zhuoqiao Wang ; MS^c ; Ron D. Hays ; PhD^d ; K. Robin Yabroff ; PhD^b ; Marie Topor ; MS^c ; Eric J. Feuer ; PhD^b
• 关键词：Prognosis ; clinical prediction model ; elderly ; health-related quality of life
• 刊名：Journal of Pain and Symptom Management
• 出版年：2012
• 出版时间：March 2012
• 年：2012
• 卷：43
• 期：3
• 页码：527-539
• 全文大小：301 K

文摘

Context

Estimation of six-month prognosis is essential in hospice referral decisions, but accurate, evidence-based tools to assist in this task are lacking.

Objectives

To develop a new prognostic model, the Patient-Reported Outcome Mortality Prediction Tool (PROMPT), for six-month mortality in community-dwelling elderly patients.

Methods

We used data from the Medicare Health Outcomes Survey linked to vital status information. Respondents were 65 years old or older, with self-reported declining health over the past year (n = 21,870), identified from four Medicare Health Outcomes Survey cohorts (1998-2000, 1999-2001, 2000-2002, and 2001-2003). A logistic regression model was derived to predict six-month mortality, using sociodemographic characteristics, comorbidities, and health-related quality of life (HRQOL), ascertained by measures of activities of daily living and the Medical Outcomes Study Short Form-36 Health Survey; k-fold cross-validation was used to evaluate model performance, which was compared with existing prognostic tools.

Results

The PROMPT incorporated 11 variables, including four HRQOL domains: general health perceptions, activities of daily living, social functioning, and energy/fatigue. The model demonstrated good discrimination (c-statistic = 0.75) and calibration. Overall diagnostic accuracy was superior to existing tools. At cut points of 10 % -70 % , estimated six-month mortality risk sensitivity and specificity ranged from 0.8 % to 83.4 % and 51.1 % to 99.9 % , respectively, and positive likelihood ratios at all mortality risk cut points ?0 % exceeded 5.0. Corresponding positive and negative predictive values were 23.1 % -64.1 % and 85.3 % -94.5 % . Over 50 % of patients with estimated six-month mortality risk ?0 % died within 12 months.

Conclusion

The PROMPT, a new prognostic model incorporating HRQOL, demonstrates promising performance and potential value for hospice referral decisions. More work is needed to evaluate the model.