Assessing patient prognosis (ePrognosis)

Lindsay Yourman and colleagues have a paper in JAMA this week reviewing prognostic indices for older adults.

Even more interesting, this team of colleagues from UCSF has developed an on-line tool, ePrognosis that provides a simple way to enter patient information into 16 predictive tools and receive a predicted life span based on the entered characteristics. The entry portal on the web site provides a list of different indices arrayed by time frame of the assessment tool, and the quality of the tool as assessed in the paper published in JAMA. Shown below are the community based mortality indices available; 16 different indices are available, some based on transitions such as hospitalization or nursing home admission. The size of the bubbles are driven by how often each index is used on ePrognosis, as well as by the degree to which users rated the tool as useful.

For example, I used the Porock score which provides a prediction of 6 month mortality risk of institutionalized persons and is often used to inform hospice eligibility decisions, entered information for a fictitious patient and it returned the following:

A predicted 69% chance of mortality within 6 months is returned. As ePrognosis notes, this is only a tool, and it is most meaningfully used by a physician/health care team that knows a patient. However, this tool appears to be a major opportunity to make evidence-based  prognostication available to busy clinicians and is a very interesting development in the field of geriatrics and palliative care.

As an accompanying editorial notes, prognostic information is often not fully considered or used in making treatment and screening decisions (should you continue routine mammogram given prognosis for CHF, for example?). ePrognosis could help mainstream the provision of objective prognostic information. This seems like a very important paper and dissemination tool to me.

DT

Lindsey C. Yourman, MD;Sei J. Lee, MD, MAS; Mara A. Schonberg, MD, MPH; Eric W. Widera, MD; Alexander K. Smith, MD, MS, MPH. Prognostic Indices for Older Adults: A Systematic Review. JAMA. 2012;307(2):182-192.

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

2 Responses to Assessing patient prognosis (ePrognosis)

  1. Weiwen Ng says:

    Very, very interesting for non-clinicians as well. For example, in the two tools I experimented on, functional limitations (difficulties eating, dressing, bathing and doing other common activities of daily living*) are significantly correlated with mortality.

    * wasn’t there something in one of the MMSE posts about how we’re not really sure about the copyright status of the Katz ADL scale and it could come back to bite clinicians and researchers?

  2. Don Taylor says:

    @Weiwen
    Here is the post on ownership of the MMSE http://theincidentaleconomist.com/wordpress/who-owns-the-mmse/
    there are issues about scales that are derivative of the MMSE….many are critical of this since MMSE was derivative of other scales.

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