Predicting 1‐Year Mortality in Older Hospitalized Patients: External Validation of the HOMR Model

Predicting 1‐Year Mortality in Older Hospitalized Patients: External Validation of the HOMR Model

OBJECTIVES Accurate prognostic information can enable patients and physicians to make better healthcare decisions. The Hospital‐patient One‐year Mortality Risk (HOMR) model accurately predicted mortality risk (concordance [C] statistic = .92) in adult hospitalized patients in a recent study in North...

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Published in:Journal of the American Geriatrics Society (JAGS) Vol. 67; no. 7; pp. 1478 - 1483
Main Authors: Curtin, Denis, Dahly, Darren L., Smeden, Maarten, O'Donnell, Desmond P., Doyle, David, Gallagher, Paul, O'Mahony, Denis
Format: Journal Article
Language:English
Published: Hoboken, USA John Wiley & Sons, Inc 01-07-2019
Wiley Subscription Services, Inc
Subjects:
Aged
Aged, 80 and over
end‐of‐life care
Female
Geriatric Assessment
HOMR model
Hospital Mortality - trends
Hospitalization
Humans
Information systems
Male
Medical prognosis
Models, Statistical
Mortality
North America
Older people
Patients
prediction model
Predictive Value of Tests
Prognosis
prognosis in older people
prognostic estimates
Retrospective Studies
Survival Analysis
North America
prognosis in older people
prognostic estimates
prediction model
HOMR model
end-of-life care
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Summary:OBJECTIVES Accurate prognostic information can enable patients and physicians to make better healthcare decisions. The Hospital‐patient One‐year Mortality Risk (HOMR) model accurately predicted mortality risk (concordance [C] statistic = .92) in adult hospitalized patients in a recent study in North America. We evaluated the performance of the HOMR model in a population of older inpatients in a large teaching hospital in Ireland. DESIGN Retrospective cohort study. SETTING Acute hospital. PARTICIPANTS Patients aged 65 years or older cared for by inpatient geriatric medicine services from January 1, 2013, to March 6, 2015 (n = 1654). After excluding those who died during the index hospitalization (n = 206) and those with missing data (n = 39), the analytical sample included 1409 patients. MEASUREMENTS Administrative data and information ed from hospital discharge reports were used to determine covariate values for each patient. One‐year mortality was determined from the hospital information system, local registries, or by contacting the patient's general practitioner. The linear predictor for each patient was calculated, and performance of the model was evaluated in terms of its overall performance, discrimination, and calibration. Recalibrated and revised models were also estimated and evaluated. RESULTS One‐year mortality rate after hospital discharge in this patient cohort was 18.6%. The unadjusted HOMR model had good discrimination (C statistic = .78; 95% confidence interval = .76‐.81) but was poorly calibrated and consistently overestimated mortality prediction. The model's performance was modestly improved by recalibration and revision (optimism corrected C statistic = .8). CONCLUSION The superior discriminative performance of the HOMR model reported previously was substantially attenuated in its application to our cohort of older hospitalized patients, who represent a specific subset of the original derivation cohort. Updating methods improved its performance in our cohort, but further validation, refinement, and clinical impact studies are required before use in routine clinical practice. J Am Geriatr Soc 1‐6, 2019.
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ISSN:0002-8614
1532-5415
DOI:10.1111/jgs.15958