Caring about prognosis: a validation study of the caring criteria to identify hospitalized patients at high risk for death at 1 year.
BACKGROUND
Identifying patients, at the time of hospital admission, who are at high risk for 1-year mortality is an ideal opportunity to introduce palliative interventions into the hospital care plan. The CARING (C = primary diagnosis of cancer, A = ≥ 2 admissions to the hospital for a chronic illness within the last year; R = resident in a nursing home; I = intensive care unit admission with multiorgan failure, NG = noncancer hospice guidelines [meeting ≥ 2 of the National Hospice and Palliative Care Organization's guidelines] criteria is a practical prognostic index developed and validated in the Veteran's Administration hospital setting that identifies patients at high risk of death within 1 year, although its effectiveness in a broader patient population is unknown.


OBJECTIVE
To validate the CARING criteria in a university and safety-net hospital setting.


METHODS
Retrospective observational cohort study.


METHODS
Inpatient.


METHODS
Adults admitted to medical and surgical inpatient services during the study period of July 2005 through August 2005.


METHODS
Mortality at 1 year following the index hospitalization was the primary end point. The CARING criteria were abstracted from the chart using only medical data available at time of admission.


RESULTS
At total of 1064 patients were admitted during the study period. Primary diagnosis of cancer (odds ratio [OR) = 7.23 [4.45-11.75]), intensive care unit admission with multiple organ failure (OR = 6.97 [2.75-17.68]), >2 noncancer hospice guidelines (OR = 15.55 [7.28-33.23]), and age (OR = 1.60 [1.32-1.93]) were predictive of 1-year mortality (C statistic = 0.79). One-year survival was significantly lower for those who met ≥ 1 of the CARING criteria.


CONCLUSIONS
The CARING criteria are a practical prognostic tool validated in a broad inpatient population that can be utilized on hospital admission to estimate risk of death in 1 year, with the goal of identifying patients who may benefit most from incorporating palliative interventions into their hospital plan of care. Journal of Hospital Medicine 2013;8:696-701. © 2013 Society of Hospital Medicine.
Hospital Medicine Group, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
Jeanie
J
Youngwerth
Sung-joon
SJ
Min
Barbara
B
Statland
Rebecca
R
Allyn
Stacy
S
Fischer
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004645:Empathy; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D010166:Palliative Care / Q000592:standards / Q000639:trends*; D010343:Patient Admission / Q000639:trends*; D005791:Patient Care / Q000592:standards / Q000639:trends*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors