title: The HOMR-Now! Model Accurately Predicts 1-Year Death Risk for Hospitalized Patients on Admission.
abstract: The Hospital-patient One-year Mortality Risk (HOMR) score is an externally validated index using health administrative data to accurately predict the risk of death within 1 year of admission to the hospital. This study derived and internally validated a HOMR modification using data that are available when the patient is admitted to the hospital.
  
  
  
  From all adult hospitalizations at our tertiary-care teaching hospital between 2004 and 2015, we randomly selected one per patient. We added to all HOMR variables that could be determined from our hospital's data systems on admission other factors that might prognosticate. Vital statistics registries determined vital status at 1 year from admission.
  
  
  
  Of 2,06,396 patients, 32,112 (15.6%) died within 1 year of admission to the hospital. The HOMR-now! model included patient (sex, comorbidities, living and cancer clinic status, and 1-year death risk from population-based life tables) and hospitalization factors (admission year, urgency, service and laboratory-based acuity score). The model explained that more than half of the total variability (Regenkirke's R2value of 0.53) was very discriminative (C-statistic 0.92), and accurately predicted death risk (calibration slope 0.98).
  
  
  
  One-year risk of death can be accurately predicted using routinely collected data available when patients are admitted to the hospital.
authors.affiliation: Departments of Medicine and Epidemiology & Community Medicine, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ontario, Canada; Institute for Clinical Evaluative Sciences (ICES@uOttawa), Ontario, Canada. Electronic address: carlv@ohri.ca.
authors.forename: Carl
authors.initials: C
authors.lastname: van Walraven
authors.affiliation: Departments of Medicine and Epidemiology & Community Medicine, University of Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ontario, Canada; The Ottawa Hospital, Ontario, Canada.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Forster
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D015993:Life Tables; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D009026:Mortality; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index; D017678:Sex Distribution; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
keywords: Administrative data; Calibration; Discrimination; Hospitalization; Mortality; Multivariate logistic regression; Risk index; Risk model; Risk score; Survival