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

Publication ,  Journal Article
Han, PKJ; Lee, M; Reeve, BB; Mariotto, AB; Wang, Z; Hays, RD; Yabroff, KR; Topor, M; Feuer, EJ
Published in: J Pain Symptom Manage
March 2012

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.

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Published In

J Pain Symptom Manage

DOI

EISSN

1873-6513

Publication Date

March 2012

Volume

43

Issue

3

Start / End Page

527 / 539

Location

United States

Related Subject Headings

  • United States
  • Survival Analysis
  • Socioeconomic Factors
  • Sex Factors
  • Reproducibility of Results
  • Quality of Life
  • Prognosis
  • Outcome Assessment, Health Care
  • Mortality
  • Models, Statistical
 

Citation

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Chicago
ICMJE
MLA
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Han, P. K. J., Lee, M., Reeve, B. B., Mariotto, A. B., Wang, Z., Hays, R. D., … Feuer, E. J. (2012). Development of a prognostic model for six-month mortality in older adults with declining health. J Pain Symptom Manage, 43(3), 527–539. https://doi.org/10.1016/j.jpainsymman.2011.04.015
Han, Paul K. J., Minjung Lee, Bryce B. Reeve, Angela B. Mariotto, Zhuoqiao Wang, Ron D. Hays, K Robin Yabroff, Marie Topor, and Eric J. Feuer. “Development of a prognostic model for six-month mortality in older adults with declining health.J Pain Symptom Manage 43, no. 3 (March 2012): 527–39. https://doi.org/10.1016/j.jpainsymman.2011.04.015.
Han PKJ, Lee M, Reeve BB, Mariotto AB, Wang Z, Hays RD, et al. 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.
Han, Paul K. J., et al. “Development of a prognostic model for six-month mortality in older adults with declining health.J Pain Symptom Manage, vol. 43, no. 3, Mar. 2012, pp. 527–39. Pubmed, doi:10.1016/j.jpainsymman.2011.04.015.
Han PKJ, Lee M, Reeve BB, Mariotto AB, Wang Z, Hays RD, Yabroff KR, Topor M, Feuer EJ. Development of a prognostic model for six-month mortality in older adults with declining health. J Pain Symptom Manage. 2012 Mar;43(3):527–539.
Journal cover image

Published In

J Pain Symptom Manage

DOI

EISSN

1873-6513

Publication Date

March 2012

Volume

43

Issue

3

Start / End Page

527 / 539

Location

United States

Related Subject Headings

  • United States
  • Survival Analysis
  • Socioeconomic Factors
  • Sex Factors
  • Reproducibility of Results
  • Quality of Life
  • Prognosis
  • Outcome Assessment, Health Care
  • Mortality
  • Models, Statistical