Caring about prognosis: a validation study of the caring criteria to identify hospitalized patients at high risk for death at 1 year

J Hosp Med. 2013 Dec;8(12):696-701. doi: 10.1002/jhm.2107. Epub 2013 Nov 13.


Background: Identifying patients, at the time of hospital admission, who are at high risk for 1-year mortality is an ideal opportunity to introduce palliative interventions into the hospital care plan. The CARING (C = primary diagnosis of cancer, A = ≥ 2 admissions to the hospital for a chronic illness within the last year; R = resident in a nursing home; I = intensive care unit admission with multiorgan failure, NG = noncancer hospice guidelines [meeting ≥ 2 of the National Hospice and Palliative Care Organization's guidelines] criteria is a practical prognostic index developed and validated in the Veteran's Administration hospital setting that identifies patients at high risk of death within 1 year, although its effectiveness in a broader patient population is unknown.

Objective: To validate the CARING criteria in a university and safety-net hospital setting.

Design: Retrospective observational cohort study.

Setting: Inpatient.

Patients: Adults admitted to medical and surgical inpatient services during the study period of July 2005 through August 2005.

Measurements: Mortality at 1 year following the index hospitalization was the primary end point. The CARING criteria were abstracted from the chart using only medical data available at time of admission.

Results: At total of 1064 patients were admitted during the study period. Primary diagnosis of cancer (odds ratio [OR) = 7.23 [4.45-11.75]), intensive care unit admission with multiple organ failure (OR = 6.97 [2.75-17.68]), >2 noncancer hospice guidelines (OR = 15.55 [7.28-33.23]), and age (OR = 1.60 [1.32-1.93]) were predictive of 1-year mortality (C statistic = 0.79). One-year survival was significantly lower for those who met ≥ 1 of the CARING criteria.

Conclusions: The CARING criteria are a practical prognostic tool validated in a broad inpatient population that can be utilized on hospital admission to estimate risk of death in 1 year, with the goal of identifying patients who may benefit most from incorporating palliative interventions into their hospital plan of care. Journal of Hospital Medicine 2013;8:696-701. © 2013 Society of Hospital Medicine.

Publication types

  • Multicenter Study
  • Observational Study
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Cohort Studies
  • Empathy*
  • Female
  • Hospitalization / trends
  • Humans
  • Male
  • Middle Aged
  • Mortality / trends*
  • Palliative Care / standards
  • Palliative Care / trends*
  • Patient Admission / trends*
  • Patient Care / standards
  • Patient Care / trends*
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index*
  • Time Factors