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Original research
mHOMR: a prospective observational study of an automated mortality prediction model to identify patients with unmet palliative needs
  1. Pete Wegier1,2,3,
  2. Allison Kurahashi4,
  3. Stephanie Saunders5,
  4. Bhadra Lokuge4,
  5. Leah Steinberg3,4,
  6. Jeff Myers3,4,6,
  7. Ellen Koo7,
  8. Carl van Walraven8,9,10 and
  9. James Downar9,11,12
  1. 1 Humber River Hospital, Toronto, Ontario, Canada
  2. 2 Institute for Health Policy, Management, & Evaluation, University of Toronto, Toronto, Ontario, Canada
  3. 3 Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4 Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada
  5. 5 Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
  6. 6 Albert and Temmy Latner Family Palliative Care Unit, Bridgepoint Active Healthcare, Toronto, Ontario, Canada
  7. 7 Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
  8. 8 Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  9. 9 Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  10. 10 Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
  11. 11 Division of Palliative Care, Ottawa Hospital, Ottawa, Ontario, Canada
  12. 12 Bruyere Research Institute, Ottawa, Ontario, Canada
  1. Correspondence to Dr Pete Wegier, Humber River Hospital, Toronto, Canada; pwegier{at}hrh.ca

Abstract

Objective Identification of patients with shortened life expectancy is a major obstacle to delivering palliative/end-of-life care. We previously developed the modified Hospitalised-patient One-year Mortality Risk (mHOMR) model for the automated identification of patients with an elevated 1-year mortality risk. Our goal was to investigate whether patients identified by mHOMR at high risk for mortality in the next year also have unmet palliative needs.

Method We conducted a prospective observational study at two quaternary healthcare facilities in Toronto, Canada, with patients admitted to general internal medicine service and identified by mHOMR to have an expected 1-year mortality risk of 10% or more. We measured patients’ unmet palliative needs—a severe uncontrolled symptom on the Edmonton Symptom Assessment Scale or readiness to engage in advance care planning (ACP) based on Sudore’s ACP Engagement Survey.

Results Of 518 patients identified by mHOMR, 403 (78%) patients consented to participate; 87% of those had either a severe uncontrolled symptom or readiness to engage in ACP, and 44% had both. Patients represented frailty (38%), cancer (28%) and organ failure (28%) trajectories were admitted for a median of 6 days, and 94% survived to discharge.

Conclusions A large majority of hospitalised patients identified by mHOMR have unmet palliative needs, regardless of disease, and are identified early enough in their disease course that they may benefit from a palliative approach to their care. Adoption of such a model could improve the timely introduction of a palliative approach for patients, especially those with non-cancer illness.

  • clinical assessment
  • clinical decisions
  • end of life care
  • prognosis
  • quality of life
  • supportive care

Data availability statement

No data are available. We did not secure ethics approval to share the data in this study.

https://doi.org/10.1136/bmjspcare-2020-002870

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    Data availability statement

    No data are available. We did not secure ethics approval to share the data in this study.

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    Footnotes

    • X @petewegier

    • Contributors JD, LS and JM conceived the study and developed the protocol. PW and JD led the drafting of the manuscript. All authors contributed to data collection and/or analysis and interpretation, revising the manuscript, and approved the final version submitted for publication.

    • Funding This research is funded by Canadian Frailty Network (Technology Evaluation in the Elderly Network), which is supported by the Government of Canada through the Networks of Centres of Excellence programme. This project was also supported financially by the Temmy Latner Centre for Palliative Care and the Toronto General/Toronto Western Foundation, and received in-kind support from the Ottawa Hospital Research Institute. JD received support for this project from the Associated Medical Services, Incorporated through a Phoenix Fellowship.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.