RT Journal Article
SR Electronic
T1 mHOMR: a prospective observational study of an automated mortality prediction model to identify patients with unmet palliative needs
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP e969
OP e975
DO 10.1136/bmjspcare-2020-002870
VO 14
IS e1
A1 Wegier, Pete
A1 Kurahashi, Allison
A1 Saunders, Stephanie
A1 Lokuge, Bhadra
A1 Steinberg, Leah
A1 Myers, Jeff
A1 Koo, Ellen
A1 van Walraven, Carl
A1 Downar, James
YR 2024
UL http://spcare.bmj.com/content/14/e1/e969.abstract
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.