Development of a prognostic model for six-month mortality in older adults with declining health

J Pain Symptom Manage. 2012 Mar;43(3):527-39. doi: 10.1016/j.jpainsymman.2011.04.015. Epub 2011 Nov 8.

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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Activities of Daily Living
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Algorithms*
  • Comorbidity
  • Ethnic Groups
  • Female
  • Health Status*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Models, Statistical
  • Mortality*
  • Outcome Assessment, Health Care / methods*
  • Prognosis*
  • Quality of Life
  • Reproducibility of Results
  • Sex Factors
  • Socioeconomic Factors
  • Survival Analysis
  • United States / epidemiology