Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
BMJ Open. 2021 Aug 25;11(8):e048168. doi: 10.1136/bmjopen-2020-048168.
Older multimorbid adults have a high risk of mortality and a short life expectancy (LE). Providing high-value care and avoiding care overuse, including of preventive care, is a serious challenge among multimorbid patients. While guidelines recommend to tailor preventive care according to the estimated LE, there is no tool to estimate LE in this specific population. Our objective is therefore to develop an LE estimator for older multimorbid adults by transforming a mortality prognostic index, which will be developed and internally validated in a prospective cohort.
We will analyse data of the Optimising Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older People cohort study in Bern, Switzerland. 822 participants were included at hospitalisation with age of 70 years or older, multimorbidity (three or more chronic medical conditions) and polypharmacy (use of five drugs or more for 30 days). All-cause mortality will be assessed during 3 years of follow-up. We will apply a flexible parametric survival model with backward stepwise selection to identify the mortality risk predictors. The model will be internally validated using bootstrapping techniques. We will derive a point-based risk score from the regression coefficients. We will transform the 3-year mortality prognostic index into an LE estimator using the Gompertz survival function. We will perform a qualitative assessment of the clinical usability of the LE estimator and its application. We will conduct the development and validation of the mortality prognostic index following the Prognosis Research Strategy (PROGRESS) framework and report it following the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) statement.
Written informed consent by patients themselves or, in the case of cognitive impairment, by a legal representative, was required before enrolment. The local ethics committee (Kantonale Ethikkommission Bern) has approved the study. We plan to publish the results in peer-reviewed journals and present them at national and international conferences.
患有多种合并症的老年患者死亡率高，预期寿命（LE）短。为患有多种合并症的患者提供高价值的护理并避免过度护理，包括预防性护理，是一项严峻的挑战。虽然指南建议根据估计的 LE 来定制预防性护理，但目前尚无针对该特定人群的 LE 估计工具。因此，我们的目标是通过将一个死亡率预后指数转化为一个 LE 估计器，来为患有多种合并症的老年患者开发一个 LE 估计器，该指数将在一个前瞻性队列中进行开发和内部验证。
我们将分析瑞士伯尔尼的 Optimising Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older People 队列研究的数据。822 名参与者在住院时年龄在 70 岁或以上，患有多种合并症（三种或更多慢性疾病）和多种药物治疗（使用五种或更多药物 30 天）。将在 3 年的随访期间评估全因死亡率。我们将应用带有向后逐步选择的灵活参数生存模型来识别死亡率风险预测因素。该模型将使用自举技术进行内部验证。我们将从回归系数中得出一个基于点的风险评分。我们将使用 Gompertz 生存函数将 3 年死亡率预后指数转化为 LE 估计器。我们将对 LE 估计器的临床可用性及其应用进行定性评估。我们将按照预后研究策略（PROGRESS）框架开发和验证死亡率预后指数，并按照多变量个体预后或诊断预测模型的透明报告（TRIPOD）声明报告结果。
在登记前，患者本人或在认知障碍的情况下，由法定代表人书面同意。当地伦理委员会（伯尔尼州伦理委员会）已批准该研究。我们计划在同行评议的期刊上发表研究结果，并在国内外会议上展示研究结果。
