期刊
JOURNAL OF CLINICAL EPIDEMIOLOGY
卷 130, 期 -, 页码 1-12出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jclinepi.2020.10.006
关键词
Multimorbidity; Polypharmacy; Elderly; Patient-centered care; Quality of life; Functional status; Prognostic model
资金
- German Innovation Funds [01VSF16018]
- Physician-Scientist Program of Heidelberg University, Faculty of Medicine
- NIHR Oxford Biomedical Research Council (BRC)
- NIHR Oxford MedTech and In-Vitro Diagnostics Co-operative (MIC)
- NIHR Applied Research Collaboration (ARC) Oxford and Thames Valley
- Oxford Martin School
- National Institute for Health Research School for Primary Care (NIHR SPCR Launching Fellowship)
The study developed and validated a prognostic model to predict deterioration in health-related quality of life in older general practice patients with chronic conditions. The model, validated internally and by internal-external cross-validation, showed good discrimination, calibration, and generalizability. Variables related to chronic conditions, inappropriate medication, functional status, well-being, and HRQoL were identified as strong predictors of deterioration in HRQoL.
Objectives: To develop and validate a prognostic model to predict deterioration in health-related quality of life (dHRQoL) in older general practice patients with at least one chronic condition and one chronic prescription. Study Design and Setting: We used individual participant data from five cluster-randomized trials conducted in the Netherlands and Germany to predict dHRQoL, defined as a decrease in EQ-5D-3 L index score of > 5% after 6-month follow-up in logistic regression models with stratified intercepts to account for between-study heterogeneity. The model was validated internally and by using internal -external cross-validation (IECV). Results: In 3,582 patients with complete data, of whom 1,046 (29.2%) showed deterioration in HRQoL, and 12/87 variables were selected that were related to single (chronic) conditions, inappropriate medication, medication underuse, functional status, well-being, and HRQoL. Bootstrap internal validation showed a C-statistic of 0.71 (0.69 to 0.72) and a calibration slope of 0.88 (0.78 to 0.98). In the IECV loop, the model provided a pooled C-statistic of 0.68 (0.65 to 0.70) and calibration-in-the-large of 0 (-0.13 to 0.13). HRQoL/functionality had the strongest prognostic value. Conclusion: The model performed well in terms of discrimination, calibration, and generalizability and might help clinicians identify older patients at high risk of dHRQoL. Registration: PROSPERO ID: CRD42018088129. (c) 2020 Elsevier Inc. All rights reserved.
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