Identifying patients at risk of inhospital death or hospice transfer for early goals of care discussions in a US referral center: the HELPS model derived from retrospective data

• Published in: BMJ open Vol. 8; no. 1; p. e015550
• Main Authors: Romero-Brufau, Santiago, Whitford, Daniel, Whitford, Kevin J, Manning, Dennis M, Huddleston, Jeanne M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.01.2018; BMJ Publishing Group
• Subjects: Activities of daily living; Adolescent; Adult; Aged; Aged, 80 and over; Comorbidity; Family medical history; Female; Hospice Care; Hospital Mortality; Hospitals; Humans; Intensive care; Logistic Models; Male; Marital status; Medical records; Medical referrals; Middle Aged; Minnesota; Mortality; Multivariate Analysis; Nutrition; Palliative Care; Parenteral nutrition; Patient Care Planning; Patient Transfer - statistics & numerical data; Patients; Physiology; Retrospective Studies; Risk Assessment; Severity of Illness Index; Variables; Young Adult; United States > US; mortality; application; hospice; clinical prediction rule
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-015550

ObjectiveCreate a score to identify patients at risk of death or hospice placement who may benefit from goals of care discussion earlier in the hospitalisation.DesignRetrospective cohort study to develop a risk index using multivariable logistic regression.SettingTwo tertiary care hospitals in Southeastern Minnesota.Participants92 879 adult general care admissions (50% male, average age 60 years).Primary and secondary outcome measuresOur outcome measure was an aggregate of inhospital death or discharge to hospice. Predictor variables for the model encompassed comorbidities, nutrition status, functional status, demographics, fall risk, mental status, Charlson Comorbidity Index and acuity of illness on admission. Resuscitation status, race, geographic area of residence and marital status were added as covariates to account for confounding.ResultsInhospital mortality and discharge to hospice were rare, with incidences of 1.2% and 0.8%, respectively. The Hospital End-of-Life Prognostic Score (HELPS) demonstrated good discrimination (C-statistic=0.866 in derivation set and 0.834 in validation set). The patients with the highest 5% of scores had an 8% risk of the outcome measure, relative risk 12.9 (10.9–15.4) when compared to the bottom 95%.ConclusionsHELPS is able to identify patients with a high risk of inhospital death or need for hospice at discharge. These patients may benefit from early goals of care discussions.