Predictors of six-month mortality among nursing home residents: diagnoses may be more predictive than functional disability.
OBJECTIVE
Loss of daily living functions can be a marker for end of life and possible hospice eligibility. Unfortunately, data on patient's functional abilities is not available in all settings. In this study we compare predictive accuracy of two indices designed to predict 6-month mortality among nursing home residents. One is based on traditional measures of functional deterioration and the other on patients' diagnoses and demography.


METHODS
We created the Hospice ELigibility Prediction (HELP) Index by examining mortality of 140,699 Veterans Administration (VA) nursing home residents. For these nursing home residents, the available data on history of hospital admissions were divided into training (112,897 cases) and validation (27,832 cases) sets. The training data were used to estimate the parameters of the HELP Index based on (1) diagnoses, (2) age on admission, and (3) number of diagnoses at admission. The validation data were used to assess the accuracy of predictions of the HELP Index. The cross-validated accuracy of the HELP Index was compared with the Barthel Index (BI) of functional ability obtained from 296,052 VA nursing home residents. A receiver operating characteristic curve was used to examine sensitivity and specificity of the predicted odds of mortality.


RESULTS
The area under the curve (AUC) for the HELP Index was 0.838. This was significantly (α <0.01) higher than the AUC for the BI of 0.692.


CONCLUSIONS
For nursing home residents, comorbid diagnoses predict 6-month mortality more accurately than functional status. The HELP Index can be used to estimate 6-month mortality from hospital data and can guide prognostic discussions prior to and following nursing home admission.
1 Denver Veteran Administration Medical Center , Denver, Colorado.
Cari
C
Levy
Raya
R
Kheirbek
Farrokh
F
Alemi
Janusz
J
Wojtusiak
Bryce
B
Sutton
Arthur R
AR
Williams
Allison
A
Williams
D000369:Aged, 80 and over; D004608:Eligibility Determination / Q000706:statistics & numerical data*; D005260:Female; D005544:Forecasting; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006707:Homes for the Aged; D017051:Hospice Care / Q000639:trends*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D009026:Mortality / Q000639:trends*; D009735:Nursing Homes / Q000639:trends*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016019:Survival Analysis; D015996:Survival Rate; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans