@article {Wegierbmjspcare-2020-002870, author = {Pete Wegier and Allison Kurahashi and Stephanie Saunders and Bhadra Lokuge and Leah Steinberg and Jeff Myers and Ellen Koo and Carl van Walraven and James Downar}, title = {mHOMR: a prospective observational study of an automated mortality prediction model to identify patients with unmet palliative needs}, elocation-id = {bmjspcare-2020-002870}, year = {2021}, doi = {10.1136/bmjspcare-2020-002870}, publisher = {British Medical Journal Publishing Group}, 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{\textquoteright} unmet palliative needs{\textemdash}a severe uncontrolled symptom on the Edmonton Symptom Assessment Scale or readiness to engage in advance care planning (ACP) based on Sudore{\textquoteright}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.No data are available. We did not secure ethics approval to share the data in this study.}, issn = {2045-435X}, URL = {https://spcare.bmj.com/content/early/2021/05/03/bmjspcare-2020-002870}, eprint = {https://spcare.bmj.com/content/early/2021/05/03/bmjspcare-2020-002870.full.pdf}, journal = {BMJ Supportive \& Palliative Care} }