{"id":2624,"date":"2021-07-05T00:00:00","date_gmt":"2021-07-05T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/predicting-death-in-home-care-users-derivation-and-validation-of-the-risk-evaluation-for-support-predictions-for-elder-life-in-the-community-tool-respect\/"},"modified":"2023-06-14T20:13:00","modified_gmt":"2023-06-15T00:13:00","slug":"predicting-death-in-home-care-users-derivation-and-validation-of-the-risk-evaluation-for-support-predictions-for-elder-life-in-the-community-tool-respect","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/predicting-death-in-home-care-users-derivation-and-validation-of-the-risk-evaluation-for-support-predictions-for-elder-life-in-the-community-tool-respect\/","title":{"rendered":"Predicting death in home care users: derivation and validation of the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT)"},"content":{"rendered":"<p><strong>Background <\/strong>&#x2014; Prognostication tools that report personalized mortality risk and survival could improve discussions about end-of-life and advance care planning. We sought to develop and validate a mortality risk model for older adults with diverse care needs in home care using self-reportable information &#8211; the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT).<\/p>\n<p><strong>Methods <\/strong>&#x2014; Using a derivation cohort that comprised adults living in Ontario, Canada, aged 50 years and older with at least 1 Resident Assessment Instrument for Home Care (RAI-HC) record between Jan. 1, 2007, and Dec. 31, 2012, we developed a mortality risk model. The primary outcome was mortality 6 months after a RAI-HC assessment. We used proportional hazards regression with robust standard errors to account for clustering by the individual. We validated this algorithm for a second cohort of users of home care who were assessed between Jan. 1 and Dec. 31, 2013. We used Kaplan-Meier survival curves to estimate the observed risk of death at 6 months for assessment of calibration and median survival. We constructed 61 risk groups based on incremental increases in the estimated median survival of about 3 weeks among adults at high risk and 3 months among adults at lower risk.<\/p>\n<p><strong>Results <\/strong>&#x2014; The derivation and validation cohorts included 435 009 and 139 388 adults, respectively. We identified a total of 122 823 deaths within 6 months of a RAI-HC assessment in the derivation cohort. The mean predicted 6-month mortality risk was 10.8% (95% confidence interval [CI] 10.7%-10.8%) and ranged from 1.54% (95% CI 1.53%-1.54%) in the lowest to 98.1% (95% CI 98.1%-98.2%) in the highest risk group. Estimated median survival spanned from 28 days (11 to 84 d at the 25th and 75th percentiles) in the highest risk group to over 8 years (1925 to 3420 d) in the lowest risk group. The algorithm had a c-statistic of 0.753 (95% CI 0.750-0.756) in our validation cohort.<\/p>\n<p><strong>Interpretation <\/strong>&#x2014; The RESPECT mortality risk prediction tool that makes use of readily available information can improve the identification of palliative and end-of-life care needs in a diverse older adult population receiving home care.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Background &#x2014; Prognostication tools that report personalized mortality risk and survival could improve discussions about end-of-life and advance care planning. We sought to develop and validate a mortality risk model for older adults with diverse care needs in home care using self-reportable information &#8211; the Risk Evaluation for Support: Predictions for Elder-Life in the Community [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-2624","journal_article","type-journal_article","status-publish","hentry"],"acf":{"citation":"Hsu AT, Manuel DG, Spruin S, Bennett C, Taljaard M, Beach S, Sequeira Y, Talarico R, Chalifoux M, Kobewka D, Costa AP, Bronskill SE, Tanuseputro P. <em>CMAJ<\/em>. 2021; 193(26):E997-1005. Epub 2021 Jul 5.","source_url":"https:\/\/www.cmaj.ca\/content\/193\/26\/E997.long","ices_scientist":[1159,1107,1186,1323,1141],"site":[6734],"research_program":[6740],"news_release":[],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"10394AE5-BF05-4EFA-994A-F99872B81536","sitecore_item_name":"Predicting-death-in-home-care-users-derivation-and-validation-of-the-Risk-Evaluation-for-Support","sitecore_field_values":"{\n  \"Title\": \"Predicting death in home care users: derivation and validation of the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT)\",\n  \"Short title\": \"Predicting death in home care users:\",\n  \"Summary\": \"Prognostication tools that report personalized mortality risk and survival could improve discussions about end-of-life and advance care planning.\",\n  \"Citation\": \"<p>Hsu AT, Manuel DG, Spruin S, Bennett C, Taljaard M, Beach S, Sequeira Y, Talarico R, Chalifoux M, Kobewka D, Costa AP, Bronskill SE, Tanuseputro P. <em>CMAJ<\/em>. 2021; 193(26):E997-1005. Epub 2021 Jul 5. DOI: <a href=\"https:\/\/doi.org\/10.1503\/cmaj.200022\" title=\"Opens external link\">https:\/\/doi.org\/10.1503\/cmaj.200022<\/a><\/p>\",\n  \"Abstract\": \"<p><strong>Background <\/strong>&mdash; Prognostication tools that report personalized mortality risk and survival could improve discussions about end-of-life and advance care planning. We sought to develop and validate a mortality risk model for older adults with diverse care needs in home care using self-reportable information - the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT).<\/p>n<p><strong>Methods <\/strong>&mdash; Using a derivation cohort that comprised adults living in Ontario, Canada, aged 50 years and older with at least 1 Resident Assessment Instrument for Home Care (RAI-HC) record between Jan. 1, 2007, and Dec. 31, 2012, we developed a mortality risk model. The primary outcome was mortality 6 months after a RAI-HC assessment. We used proportional hazards regression with robust standard errors to account for clustering by the individual. We validated this algorithm for a second cohort of users of home care who were assessed between Jan. 1 and Dec. 31, 2013. We used Kaplan-Meier survival curves to estimate the observed risk of death at 6 months for assessment of calibration and median survival. We constructed 61 risk groups based on incremental increases in the estimated median survival of about 3 weeks among adults at high risk and 3 months among adults at lower risk.<\/p>n<p><strong>Results <\/strong>&mdash; The derivation and validation cohorts included 435 009 and 139 388 adults, respectively. We identified a total of 122 823 deaths within 6 months of a RAI-HC assessment in the derivation cohort. The mean predicted 6-month mortality risk was 10.8% (95% confidence interval [CI] 10.7%-10.8%) and ranged from 1.54% (95% CI 1.53%-1.54%) in the lowest to 98.1% (95% CI 98.1%-98.2%) in the highest risk group. Estimated median survival spanned from 28 days (11 to 84 d at the 25th and 75th percentiles) in the highest risk group to over 8 years (1925 to 3420 d) in the lowest risk group. The algorithm had a c-statistic of 0.753 (95% CI 0.750-0.756) in our validation cohort.<\/p>n<p><strong>Interpretation <\/strong>&mdash; The RESPECT mortality risk prediction tool that makes use of readily available information can improve the identification of palliative and end-of-life care needs in a diverse older adult population receiving home care.<\/p>n<p><a href=\"https:\/\/www.cmaj.ca\/content\/193\/26\/E997.long\" title=\"Opens external link\">View full text<\/a><\/p>\",\n  \"Research Programs\": \"{46DF28D2-EDE8-4DF2-8CC0-87CEF464E435}\",\n  \"ICES Locations\": \"{0AD77E2C-C883-4E93-8B9A-40B82D50E3A5}\",\n  \"ICES Scientists\": \"{68FD9EE5-974B-4CED-A597-82186232FF1D}|{B9979611-1657-47B5-B80F-08815BA48831}|{D7E62625-10F2-4D1B-9853-B068EF71EC84}|{3178B170-580F-4CCA-A2D4-687D1150C87C}|{B0380E31-7F06-498A-B2AB-6AE853CA8C7E}\",\n  \"Posted Date\": \"20210705T000000\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2021\/July\/Predicting-death-in-home-care-users-derivation-and-validation-of-the-Risk-Evaluation-for-Support"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Predicting death in home care users: derivation and validation of the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT)<\/title>\n<meta name=\"description\" content=\"Background &#x2014; 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