title: Use of the MMRI-R prognostic tool for older patients discharged to nursing homes from hospital: a prospective cohort study.
abstract: BACKGROUND
  the Minimum Dataset Mortality Risk Index-Revised (MMRI-R) is a prognostic score predicting 6-month mortality in US nursing homes. It has not been validated in the UK nor at the hospital-nursing home interface.
  
  
  METHODS
  prospective cohort study of consecutive patients discharged from hospital or intermediate care to nursing homes from January 2012 to January 2014. MMRI-R scoring was done prior to discharge and subsequent deaths were ascertained. Calibration plots, receiver operative characteristic curves with area under the curve (AUC) and an optimal cutpoint were obtained. Kaplan-Meier curves were plotted with scores stratified by the cutpoint.
  
  
  RESULTS
  a total of 183 patients were followed up for a median of 230 days. Median age was 87 years and 55.7% were female. Median MMRI-R score was 55. By the end of follow-up, 99 patients (54.1%) were dead. The Hosmer-Lemeshow test showed P-values of 0.4406 for 3-month and 0.8904 for 6-month mortality. The AUC was 0.70 (95% CI: 0.622-0.777) for 3-month death prediction and 0.723 (95% CI: 0.649-0.797) for death at 6 months. Of patients with MMRI-R scores >48 (the cutpoint), 43.6% were dead at 3 months and 53.6% by 6 months. The corresponding figures for scores <48 were 9.6 and 16.4% (P < 0.001, log-rank test).
  
  
  CONCLUSIONS
  the MMRI-R can be used at the acute hospital/nursing home interface, and can help predict 3-month and 6-month mortality. The finding of an MMRI-R score of ≥48 should trigger end-of-life discussions.
authors: Worcestershire Royal Hospital - Elderly Care, Charles Hastings Way Worcester WR5 1DD, Worcester, Worcestershire WR5 1DD, UK.
authors: Ruma
authors: R
authors: Dutta
authors: Timberdine Nursing and Rehabilitation Unit, Worcester, Worcestershire, UK.
authors: Julie
authors: J
authors: Hooper
authors: Gloucestershire Royal Hospital - General and Old Age Medicine, Gloucester, Gloucestershire, UK.
authors: Dipankar
authors: D
authors: Dutta
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010351:Patient Discharge; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: end-of-life care; nursing homes; older people; risk stratification