The art versus science of predicting prognosis: can a prognostic index predict short-term mortality better than experienced nurses do?

Journal of Palliative Medicine
David CasarettJoan M Teno

Abstract

To determine whether a prognostic index could predict one-week mortality more accurately than hospice nurses can. An electronic health record-based retrospective cohort study of 21,074 hospice patients was conducted in three hospice programs in the Southeast, Northeast, and Midwest United States. Model development used logistic regression with bootstrapped confidence intervals and multiple imputation to account for missing data. The main outcome measure was mortality within 7 days of hospice enrollment. A total of 21,074 patients were admitted to hospice between October 1, 2008 and May 31, 2011, and 5562 (26.4%) died within 7 days. An optimal predictive model included the Palliative Performance Scale (PPS) score, admission from a hospital, and gender. The model had a c-statistic of 0.86 in the training sample and 0.84 in the validation sample, which was greater than that of nurses' predictions (0.72). The index's performance was best for patients with pulmonary disease (0.89) and worst for patients with cancer and dementia (both 0.80). The index's predictions of mortality rates in each index category were within 5.0% of actual rates, whereas nurses underestimated mortality by up to 18.9%. Using the optimal index threshold (<3),...Continue Reading

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Citations

Mar 22, 2014·BMC Medical Research Methodology·Gary S CollinsDouglas G Altman
May 6, 2015·Journal of Pain and Symptom Management·David CasarettJoan Teno
May 18, 2016·Journal of the American Medical Informatics Association : JAMIA·Benjamin A GoldsteinJohn P A Ioannidis
Jan 8, 2017·Journal of Pain and Symptom Management·Claribel P L SimmonsBarry J Laird
Apr 23, 2017·Journal of the American Medical Directors Association·Lucas MorinKristina Johnell
Jun 2, 2018·Cancer Medicine·Carlos Eduardo PaivaEduardo Bruera
Jun 5, 2012·Journal of Palliative Medicine·Charles F von Gunten

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