Prognosticating with the hospitalized patient one-year mortality risk score using information abstracted from the medical record

Background — Predicting death risk in patients with diverse conditions is difficult. The Hospitalized-patient One-year Mortality Risk (HOMR) score accurately determines death risk in adults admitted to hospital using health administrative data unavailable to clinicians and most researchers.

Objective — Determine if HOMR is valid when calculated using data abstracted directly from the medical record.

Design — Medical record review linked to population-based administrative data.

Participants — 4,996 adults admitted in 2011 to a nonpsychiatric service at a tertiary hospital.

Main Measures — From the chart, we abstracted information required to calculate the HOMR score and linked to population-based mortality data to determine vital status within 1 year of admission date.

Key Results — Patients had a mean age of 55.6 (standard deviation [SD], 20.7) with 563 (11.3%) dying. The mean chart HOMR score was 22 (SD, 12) and significantly predicted death risk; a 1-point increase in HOMR increased death odds by 19% (odds ratio, 1.192;, 95% confidence interval [CI], 1.175-1.210;, P < 0.0001). Chart HOMR was strongly discriminative ( C statistic 0.888) and well calibrated (Hosmer-Lemeshow goodness-of-fit test, 12.9; P = 0.11). The observed death risk was strongly associated with expected death risk (calibration slope, 1.02; 95% CI, 0.89-1.16). Notation of delirium or falls on admitting notes or dependence for at least 1 activity of daily living were each associated with 1-year death risk independent of the HOMR score.

Conclusions — One-year mortality risk can be accurately determined in adults admitted to hospital with the HOMR score calculated using information abstracted from the medical record. Patient functional status was independently associated with death risk.