title: Moderate efficiency of clinicians' predictions decreased for blurred clinical conditions and benefits from the use of BRASS index. A longitudinal study on geriatric patients' outcomes.
abstract: OBJECTIVE
  Accurate prognosis is an essential aspect of good clinical practice and efficient health services, particularly for chronic and disabling diseases, as in geriatric populations. This study aims to examine the accuracy of clinical prognostic predictions and to devise prediction models combining clinical variables and clinicians' prognosis for a geriatric patient sample.
  
  
  METHODS
  In a sample of 329 consecutive older patients admitted to 10 geriatric units, we evaluated the accuracy of clinicians' prognosis regarding three outcomes at discharge: global functioning, length of stay (LoS) in hospital, and destination at discharge (DD). A comprehensive set of sociodemographic, clinical, and treatment-related information were also collected.
  
  
  RESULTS
  Moderate predictive performance was found for all three outcomes: area under receiver operating characteristic curve of 0.79 and 0.78 for functioning and LoS, respectively, and moderate concordance, Cohen's K = 0.45, between predicted and observed DD. Predictive models found the Blaylock Risk Assessment Screening Score together with clinicians' judgment relevant to improve predictions for all outcomes (absolute improvement in adjusted and pseudo-R(2) up to 19%).
  
  
  CONCLUSIONS
  Although the clinicians' estimates were important factors in predicting global functioning, LoS, and DD, more research is needed regarding both methodological aspects and clinical measurements, to improve prognostic clinical indices.
authors.affiliation: Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Signorini
authors.affiliation: Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy.
authors.forename: Jessica
authors.initials: J
authors.lastname: Dagani
authors.affiliation: Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy.
authors.forename: Viola
authors.initials: V
authors.lastname: Bulgari
authors.affiliation: Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy.
authors.forename: Clarissa
authors.initials: C
authors.lastname: Ferrari
authors.affiliation: Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy. Electronic address: gdegirolamo@fatebenefratelli.eu.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Girolamo
mesh_terms: D000368:Aged; D002983:Clinical Competence; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D010351:Patient Discharge; D011379:Prognosis
keywords: Clinician; Geriatric patient; Hospitalization; Predictive models; Prognosis; Treatment outcome