Predicting 1‐year mortality in older hospitalized patients: external validation of the HOMR Model

Show simple item record

dc.contributor.author Curtin, Denis
dc.contributor.author Dahly, Darren L.
dc.contributor.author van Smeden, Maarten
dc.contributor.author O'Donnell, Desmond P.
dc.contributor.author Doyle, David
dc.contributor.author Gallagher, Paul F.
dc.contributor.author O'Mahony, Denis
dc.date.accessioned 2019-07-01T11:10:15Z
dc.date.available 2019-07-01T11:10:15Z
dc.date.issued 2019-05-03
dc.identifier.citation Curtin, D., Dahly, D. L., van Smeden, M., O'Donnell, D. P., Doyle, D., Gallagher, P. and O'Mahony, D. (2019) ‘Predicting 1‐year mortality in older hospitalized patients: external validation of the HOMR Model’, Journal of the American Geriatrics Society. doi:10.1111/jgs.15958 en
dc.identifier.issn 0002-8614
dc.identifier.uri http://hdl.handle.net/10468/8108
dc.identifier.doi 10.1111/jgs.15958 en
dc.description.abstract Objectives: Accurate prognostic information can enable patients and physicians to make better healthcare decisions. The Hospital‐patient One‐year Mortality Risk (HOMR) model accurately predicted mortality risk (concordance [C] statistic = .92) in adult hospitalized patients in a recent study in North America. We evaluated the performance of the HOMR model in a population of older inpatients in a large teaching hospital in Ireland. Design: Retrospective cohort study. Setting: Acute hospital. Participants: Patients aged 65 years or older cared for by inpatient geriatric medicine services from January 1, 2013, to March 6, 2015 (n = 1654). After excluding those who died during the index hospitalization (n = 206) and those with missing data (n = 39), the analytical sample included 1409 patients. Measurements: Administrative data and information abstracted from hospital discharge reports were used to determine covariate values for each patient. One‐year mortality was determined from the hospital information system, local registries, or by contacting the patient's general practitioner. The linear predictor for each patient was calculated, and performance of the model was evaluated in terms of its overall performance, discrimination, and calibration. Recalibrated and revised models were also estimated and evaluated. Results: One‐year mortality rate after hospital discharge in this patient cohort was 18.6%. The unadjusted HOMR model had good discrimination (C statistic = .78; 95% confidence interval = .76‐.81) but was poorly calibrated and consistently overestimated mortality prediction. The model's performance was modestly improved by recalibration and revision (optimism corrected C statistic = .8). Conclusion: The superior discriminative performance of the HOMR model reported previously was substantially attenuated in its application to our cohort of older hospitalized patients, who represent a specific subset of the original derivation cohort. Updating methods improved its performance in our cohort, but further validation, refinement, and clinical impact studies are required before use in routine clinical practice. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher John Wiley & Sons, Inc. en
dc.rights © 2019, the American Geriatrics Society. This is the peer reviewed version of the following article: Curtin, D., Dahly, D. L., van Smeden, M., O'Donnell, D. P., Doyle, D., Gallagher, P. and O'Mahony, D. (2019) ‘Predicting 1‐year mortality in older hospitalized patients: external validation of the HOMR Model’, Journal of the American Geriatrics Society. doi:10.1111/jgs.15958, which has been published in final form at https://doi.org/10.1111/jgs.15958. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. en
dc.subject Prediction model en
dc.subject Prognostic estimates en
dc.subject End‐of‐life care en
dc.subject HOMR model en
dc.subject Prognosis in older people en
dc.title Predicting 1‐year mortality in older hospitalized patients: external validation of the HOMR Model en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Denis Curtin, Medicine, University College Cork, Cork, Ireland. +353-21-490-3000 Email: deniscurtin@physicians.ie en
dc.internal.availability Full text available en
dc.check.info Access to this article is restricted until 12 months after publication by request of the publisher. en
dc.check.date 2020-05-03
dc.description.version Accepted Version en
dc.contributor.funder Horizon 2020 en
dc.description.status Peer reviewed en
dc.identifier.journaltitle Journal of the American Geriatrics Society en
dc.internal.IRISemailaddress ddahly@ucc.ie en
dc.internal.bibliocheck In press. Check vol / issue / page range. Amend citation as necessary. en
dc.relation.project info:eu-repo/grantAgreement/EC/H2020::RIA/634238/EU/OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly/OPERAM en
dc.identifier.eissn 1532-5415


Files in this item

This item appears in the following Collection(s)

Show simple item record

This website uses cookies. By using this website, you consent to the use of cookies in accordance with the UCC Privacy and Cookies Statement. For more information about cookies and how you can disable them, visit our Privacy and Cookies statement