Objective Stratification Of Six-Month Mortality Risk Among Patients Referred To Hospice
Circulation(2016)
摘要
Introduction: The Intermountain Mortality Risk Scores (IMRS) are a suite of sex-specific mortality risk stratification tools created from the complete blood count (CBC), basic metabolic profile (BMP), and age. Patients referred to hospice should have probable 6-month mortality, but this is currently estimated based on clinical gestalt. Hypothesis: Use of an objective clinical decision tool like IMRS may improve estimation of 6-month mortality risk for evaluation of patient referral to hospice. Methods: Subjects were Intermountain Healthcare patients who were referred to hospice (females: n=1,753, males: n=1,522) from 2009-2014. Baseline CBC and BMP laboratory data from the time of initial referral to hospice were used to compute the previously-derived IMRS scores. Cox regression and Kaplan-Meier survival curves were used for statistical analyses to evaluate six-month all-cause mortality risk. Results: Females averaged 77.2±14.2 years of age, and males were 74.4±14.6 years. Six-month survival was 37% in females and 33% in males; stratified into IMRS deciles, survival was 44.9% in decile 1 and 27.8% in decile 10 for females, while in males survival was 39.5% and 25.2%, respectively. Females had hazard ratio (HR)=1.72 (95% CI=1.34, 2.18; p Conclusions: About one third of hospice patients did not die within 6 months, suggesting that additional objective evidence is needed to guide referral. IMRS, an evidence-based clinical decision tool derived in a large healthcare population, significantly stratified mortality risk in hospice patients. An electronically-deliverable stratification tool, IMRS may be useful in evaluation of patient risk prior to hospice referral.
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关键词
End of life, Outcomes, Mortality, Health policy
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