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

Curtin, Denis; Dahly, Darren L.; van Smeden, Maarten; O'Donnell, Desmond P.; Doyle, David; Gallagher, Paul F.; O'Mahony, Denis

Access to this article is restricted until 12 months after publication by request of the publisher.. Restriction lift date: 2020-05-03

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

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dc.check.date	2020-05-03
dc.check.info	Access to this article is restricted until 12 months after publication by request of the publisher.	en
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.contributor.funder	Horizon 2020	en
dc.date.accessioned	2019-07-01T11:10:15Z
dc.date.available	2019-07-01T11:10:15Z
dc.date.issued	2019-05-03
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.description.status	Peer reviewed	en
dc.description.version	Accepted Version	en
dc.format.mimetype	application/pdf	en
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.doi	10.1111/jgs.15958	en
dc.identifier.eissn	1532-5415
dc.identifier.issn	0002-8614
dc.identifier.journaltitle	Journal of the American Geriatrics Society	en
dc.identifier.uri	https://hdl.handle.net/10468/8108
dc.language.iso	en	en
dc.publisher	John Wiley & Sons, Inc.	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.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