PT  - JOURNAL ARTICLE
AU  - Wegier, Pete
AU  - Kurahashi, Allison
AU  - Saunders, Stephanie
AU  - Lokuge, Bhadra
AU  - Steinberg, Leah
AU  - Myers, Jeff
AU  - Koo, Ellen
AU  - van Walraven, Carl
AU  - Downar, James
TI  - mHOMR: a prospective observational study of an automated mortality prediction model to identify patients with unmet palliative needs
AID  - 10.1136/bmjspcare-2020-002870
DP  - 2024 May 01
TA  - BMJ Supportive & Palliative Care
PG  - e969--e975
VI  - 14
IP  - e1
4099  - http://spcare.bmj.com/content/14/e1/e969.short
4100  - http://spcare.bmj.com/content/14/e1/e969.full
SO  - BMJ Support Palliat Care2024 May 01; 14
AB  - 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.No data are available. We did not secure ethics approval to share the data in this study.