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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. 1Humber River Hospital, Toronto, Ontario, Canada
  2. 2Institute for Health Policy, Management, & Evaluation, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada
  5. 5Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
  6. 6Albert and Temmy Latner Family Palliative Care Unit, Bridgepoint Active Healthcare, Toronto, Ontario, Canada
  7. 7Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
  8. 8Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  9. 9Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  10. 10Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
  11. 11Division of Palliative Care, Ottawa Hospital, Ottawa, Ontario, Canada
  12. 12Bruyere 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.

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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

  • Twitter @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.

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