RT Journal Article
SR Electronic
T1 Multisystem chronic illness prognostication in non-oncologic integrated care
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP e112
OP e119
DO 10.1136/bmjspcare-2019-002055
VO 12
IS e1
A1 Pablo E Bretos-Azcona
A1 Cristina Ibarrola Guillén
A1 Eduardo Sánchez-Iriso
A1 Juan M Cabasés Hita
A1 Javier Gorricho
A1 Julián Librero López
YR 2022
UL http://spcare.bmj.com/content/12/e1/e112.abstract
AB Objectives To develop a mortality-predictive model for correct identification of patients with non-cancer multiple chronic conditions who would benefit from palliative care, recognise predictive indicators of death and provide with tools for individual risk score calculation.Design Retrospective observational study with multivariate logistic regression models.Participants All patients with high-risk multiple chronic conditions incorporated into an integrated care strategy that fulfil two conditions: (1) they belong to the top 5% of the programme’s risk pyramid according to the adjusted morbidity groups stratification tool and (2) they suffer simultaneously at least three selected chronic non-cancer pathologies (n=591).Main outcome measure 1 year mortality since patient inclusion in the programme.Results Among study participants, 201 (34%) died within the 1 year follow-up. Variables found to be independently associated to 1 year mortality were the Barthel Scale (p<0.001), creatinine value (p=0.032), existence of pressure ulcers (p=0.029) and patient global status (p<0.001). The area under the curve (AUC) for our model was 0.751, which was validated using bootstrapping (AUC=0.751) and k-fold cross-validation (10 folds; AUC=0.744). The Hosmer-Lemeshow test (p=0.761) showed good calibration.Conclusions This study develops and validates a mortality prediction model that will guide transitions of care to non-cancer palliative care services. The model determines prognostic indicators of death and provides tools for the estimation of individual death risk scores for each patient. We present a nomogram, a graphical risk calculation instrument, that favours a practical and easy use of the model within clinical practices.No data are available.