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

• Published in: Journal of pain and symptom management Vol. 43; no. 3; pp. 527 - 539
• Main Authors: Han, Paul K.J., MD, MA, MPH, Lee, Minjung, PhD, Reeve, Bryce B., PhD, Mariotto, Angela B., PhD, Wang, Zhuoqiao, MS, Hays, Ron D., PhD, Yabroff, K. Robin, PhD, Topor, Marie, MS, Feuer, Eric J., PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2012; Elsevier
• Subjects: Activities of Daily Living; Adult; Age Factors; Aged; Aged, 80 and over; Algorithms; Anesthesia & Perioperative Care; Biological and medical sciences; clinical prediction model; Comorbidity; elderly; Ethnic Groups; Female; Health; Health Status; health-related quality of life; Hospices; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Models, Statistical; Mortality; Outcome Assessment (Health Care) - methods; Pain Medicine; Pharmacology. Drug treatments; Prognosis; Quality of Life; Reproducibility of Results; Sex Factors; Socioeconomic Factors; Survival Analysis; United States - epidemiology; United States; health-related quality of life; Prognosis; clinical prediction model; elderly; Human; Health; Mortality; Prediction; Development; Models; Predictive factor; Elderly; Health-Related Quality of Life
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2011.04.015

Abstract 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 ≥40% 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 ≥30% 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.