Caring about prognosis: A validation study of the caring criteria to identify hospitalized patients at high risk for death at 1 year

摘要

BACKGROUND: Identifying patients, at the time of hospital admission, who are at high risk for 1-year mortality is an ideal opportunity to introduce palliative interventions into the hospital care plan. The CARING (C=primary diagnosis of cancer, A=≥2 admissions to the hospital for a chronic illness within the last year; R=resident in a nursing home; I=intensive care unit admission with multiorgan failure, NG=noncancer hospice guidelines [meeting ≥2 of the National Hospice and Palliative Care Organization's guidelines] criteria is a practical prognostic index developed and validated in the Veteran's Administration hospital setting that identifies patients at high risk of death within 1 year, although its effectiveness in a broader patient population is unknown. OBJECTIVE: To validate the CARING criteria in a university and safety-net hospital setting. DESIGN: Retrospective observational cohort study. SETTING: Inpatient. PATIENTS: Adults admitted to medical and surgical inpatient services during the study period of July 2005 through August 2005. MEASUREMENTS: Mortality at 1 year following the index hospitalization was the primary end point. The CARING criteria were abstracted from the chart using only medical data available at time of admission. RESULTS: At total of 1064 patients were admitted during the study period. Primary diagnosis of cancer (odds ratio [OR)=7.23 [4.45-11.75]), intensive care unit admission with multiple organ failure (OR=6.97 [2.75-17.68]), >2 noncancer hospice guidelines (OR=15.55 [7.28-33.23]), and age (OR=1.60 [1.32-1.93]) were predictive of 1-year mortality (C statistic=0.79). One-year survival was significantly lower for those who met ≥1 of the CARING criteria. CONCLUSIONS: The CARING criteria are a practical prognostic tool validated in a broad inpatient population that can be utilized on hospital admission to estimate risk of death in 1 year, with the goal of identifying patients who may benefit most from incorporating palliative interventions into their hospital plan of care. Journal of Hospital Medicine 2013;8:696-701.