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The MDS Mortality Risk Index: The evolution of a method for predicting 6-month mortality in nursing home residents.

Porock D, Parker-Oliver D, Petroski GF, Rantz M - BMC Res Notes (2010)

Bottom Line: An accurate prognosis for older adults living in a residential or nursing home can facilitate end of life decision making and planning for preferred place of care at the end of life.However, this simplification of the revised index (MMRI-R) may provide a means for facilitating prognostication and end of life discussions for application outside the USA where the MDS is not in use.Prospective testing is needed to further test the accuracy of the MMRI-R and its application in the UK and other non-MDS settings.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Nursing, Midwifery and Physiotherapy, The University of Nottingham, Nottingham, UK. davina.porock@nottingham.ac.uk.

ABSTRACT

Background: Accurate prognosis is vital to the initiation of advance care planning particularly in a vulnerable, at risk population such as care home residents. The aim of this paper is to report on the revision and simplification of the MDS Mortality Rating Index (MMRI) for use in clinical practice to predict the probability of death in six months for care home residents.

Methods: The design was a secondary analysis of a US Minimum Data Set (MDS) for long term care residents using regression analysis to identify predictors of mortality within six months.

Results: Using twelve easy to collect items, the probability of mortality within six months was accurately predicted within the MDS database. The items are: admission to the care home within three months; lost weight unintentionally in past three months; renal failure; chronic heart failure; poor appetite; male; dehydrated; short of breath; active cancer diagnosis; age; deteriorated cognitive skills in past three months; activities of daily living score.

Conclusion: A lack of recognition of the proximity of death is often blamed for inappropriate admission to hospital at the end of an older person's life. An accurate prognosis for older adults living in a residential or nursing home can facilitate end of life decision making and planning for preferred place of care at the end of life. The original MMRI was derived and validated from a large database of long term care residents in the USA. However, this simplification of the revised index (MMRI-R) may provide a means for facilitating prognostication and end of life discussions for application outside the USA where the MDS is not in use. Prospective testing is needed to further test the accuracy of the MMRI-R and its application in the UK and other non-MDS settings.

No MeSH data available.


Related in: MedlinePlus

Observed and Predicted Six Month Mortality by MMRI-R Score - Validation Data. Open circles denote observed mortality. Dots denote model-predicted average mortality and MMR-R value.
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Figure 1: Observed and Predicted Six Month Mortality by MMRI-R Score - Validation Data. Open circles denote observed mortality. Dots denote model-predicted average mortality and MMR-R value.

Mentions: To form the MMRI-R scoring system, weights were assigned to each variable by rescaling the estimated regression coefficients to integer values. Tables of tabulated values for the interaction effects suggested cut-points for these terms. The Additional File 1 gives the revised point system. The theoretical range of MMRI-R is 0 to 85 with larger values indicating greater short-term mortality risk. For our sample the mean score was 24 with a standard deviation of 10 points and a range from 0 to 75. The Spearman correlation between risk scores on the original and revised MMRI was 0.95 (p < 0.0001). Figure 1 displays the observed percent of residents who died and the model-predicted mortality at each value of MMRI-R score. Overall agreement is quite good with deviations mostly at the extreme end of the score range where death within six months is almost certain. This indicates that the complexity of the original regression model is captured well in the MMRI-R score. Area under the ROC curve for the single variable model is identical to the original model.


The MDS Mortality Risk Index: The evolution of a method for predicting 6-month mortality in nursing home residents.

Porock D, Parker-Oliver D, Petroski GF, Rantz M - BMC Res Notes (2010)

Observed and Predicted Six Month Mortality by MMRI-R Score - Validation Data. Open circles denote observed mortality. Dots denote model-predicted average mortality and MMR-R value.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2913927&req=5

Figure 1: Observed and Predicted Six Month Mortality by MMRI-R Score - Validation Data. Open circles denote observed mortality. Dots denote model-predicted average mortality and MMR-R value.
Mentions: To form the MMRI-R scoring system, weights were assigned to each variable by rescaling the estimated regression coefficients to integer values. Tables of tabulated values for the interaction effects suggested cut-points for these terms. The Additional File 1 gives the revised point system. The theoretical range of MMRI-R is 0 to 85 with larger values indicating greater short-term mortality risk. For our sample the mean score was 24 with a standard deviation of 10 points and a range from 0 to 75. The Spearman correlation between risk scores on the original and revised MMRI was 0.95 (p < 0.0001). Figure 1 displays the observed percent of residents who died and the model-predicted mortality at each value of MMRI-R score. Overall agreement is quite good with deviations mostly at the extreme end of the score range where death within six months is almost certain. This indicates that the complexity of the original regression model is captured well in the MMRI-R score. Area under the ROC curve for the single variable model is identical to the original model.

Bottom Line: An accurate prognosis for older adults living in a residential or nursing home can facilitate end of life decision making and planning for preferred place of care at the end of life.However, this simplification of the revised index (MMRI-R) may provide a means for facilitating prognostication and end of life discussions for application outside the USA where the MDS is not in use.Prospective testing is needed to further test the accuracy of the MMRI-R and its application in the UK and other non-MDS settings.

View Article: PubMed Central - HTML - PubMed

Affiliation: School of Nursing, Midwifery and Physiotherapy, The University of Nottingham, Nottingham, UK. davina.porock@nottingham.ac.uk.

ABSTRACT

Background: Accurate prognosis is vital to the initiation of advance care planning particularly in a vulnerable, at risk population such as care home residents. The aim of this paper is to report on the revision and simplification of the MDS Mortality Rating Index (MMRI) for use in clinical practice to predict the probability of death in six months for care home residents.

Methods: The design was a secondary analysis of a US Minimum Data Set (MDS) for long term care residents using regression analysis to identify predictors of mortality within six months.

Results: Using twelve easy to collect items, the probability of mortality within six months was accurately predicted within the MDS database. The items are: admission to the care home within three months; lost weight unintentionally in past three months; renal failure; chronic heart failure; poor appetite; male; dehydrated; short of breath; active cancer diagnosis; age; deteriorated cognitive skills in past three months; activities of daily living score.

Conclusion: A lack of recognition of the proximity of death is often blamed for inappropriate admission to hospital at the end of an older person's life. An accurate prognosis for older adults living in a residential or nursing home can facilitate end of life decision making and planning for preferred place of care at the end of life. The original MMRI was derived and validated from a large database of long term care residents in the USA. However, this simplification of the revised index (MMRI-R) may provide a means for facilitating prognostication and end of life discussions for application outside the USA where the MDS is not in use. Prospective testing is needed to further test the accuracy of the MMRI-R and its application in the UK and other non-MDS settings.

No MeSH data available.


Related in: MedlinePlus