دورية أكاديمية
Validation of the Patient-Reported Outcome Mortality Prediction Tool (PROMPT).
| العنوان: | Validation of the Patient-Reported Outcome Mortality Prediction Tool (PROMPT). |
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| المؤلفون: | Duarte CW; Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland; Department of Family Medicine, Maine Medical Center, Portland; Geriatric Medicine, Maine Medical Center, Portland, Maine, USA. Electronic address: duartc@mmc.org., Black AW; Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland; Department of Family Medicine, Maine Medical Center, Portland; Geriatric Medicine, Maine Medical Center, Portland, Maine, USA., Murray K; Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland; Department of Family Medicine, Maine Medical Center, Portland; Geriatric Medicine, Maine Medical Center, Portland, Maine, USA., Haskins AE; Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland; Department of Family Medicine, Maine Medical Center, Portland; Geriatric Medicine, Maine Medical Center, Portland, Maine, USA., Lucas L; Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland; Department of Family Medicine, Maine Medical Center, Portland; Geriatric Medicine, Maine Medical Center, Portland, Maine, USA., Hallen S; Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland; Department of Family Medicine, Maine Medical Center, Portland; Geriatric Medicine, Maine Medical Center, Portland, Maine, USA., Han PK; Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland; Department of Family Medicine, Maine Medical Center, Portland; Geriatric Medicine, Maine Medical Center, Portland, Maine, USA. |
| المصدر: | Journal of pain and symptom management [J Pain Symptom Manage] 2015 Aug; Vol. 50 (2), pp. 241-7.e6. Date of Electronic Publication: 2015 Apr 17. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't; Validation Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 8605836 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-6513 (Electronic) Linking ISSN: 08853924 NLM ISO Abbreviation: J Pain Symptom Manage Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: New York, NY : Elsevier Original Publication: [Madison, WI : Dept. of Anesthesiology, University of Wisconsin--Madison, 1986- |
| مواضيع طبية MeSH: | Diagnostic Self Evaluation* , Patient Outcome Assessment*, Terminal Care/*methods, Aged ; Calibration ; Decision Support Techniques ; Female ; Geriatric Assessment/methods ; Humans ; Inpatients ; Male ; Prospective Studies ; ROC Curve ; Self Report ; Sensitivity and Specificity ; Survival Analysis |
| مستخلص: | Context: The Patient-Reported Outcome Mortality Prediction Tool (PROMPT) estimates six-month mortality risk in elderly patients with declining health, but its external validity has not been established. Objectives: To prospectively validate the PROMPT in an independent patient cohort and explore its clinical utility. Methods: The study cohort comprised a diverse sample of 467 patients aged 65 years and older. Model calibration and discrimination were assessed on the original PROMPT and in two updated models. Clinical utility of the final updated PROMPT was examined using decision curve analysis. Results: The validation cohort had a lower six-month mortality rate than the derivation cohort (6.9% vs. 15.0%). Discrimination was virtually unchanged (area under the curve 0.73 compared with 0.75), but calibration was suboptimal (P < 0.05 for the Hosmer-Lemeshow test). The PROMPT, therefore, was updated with a new intercept and slope parameter that significantly improved calibration (Hosmer-Lemeshow statistic of 0.66). Specificity of the PROMPT was high (92% and 97%, respectively, at the 10% and 20% mortality risk thresholds), although sensitivity was modest (53% and 44% at the corresponding thresholds), consistent with diagnostic performance in the derivation sample. Decision curve analysis demonstrated greater net benefit of the updated PROMPT than "treat all" or "treat none" strategies, especially at low to moderate risk thresholds. Conclusion: The PROMPT demonstrated good discrimination but poor calibration in an independent heterogeneous clinical population. Model updating improved calibration and diagnostic performance and decision curve analysis demonstrated potential clinical utility of the PROMPT for initiating advance care planning rather than hospice referrals. (Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: Predictive modeling; clinical prediction models; decision curves; end-of-life care; hospice care; net benefit |
| تواريخ الأحداث: | Date Created: 20150421 Date Completed: 20161110 Latest Revision: 20191210 |
| رمز التحديث: | 20221213 |
| DOI: | 10.1016/j.jpainsymman.2015.02.028 |
| PMID: | 25891663 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1873-6513 |
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| DOI: | 10.1016/j.jpainsymman.2015.02.028 |