Prognosis and prognostic research validating a prognostic model dating set
Methods: prospective cohort study of consecutive patients discharged from hospital or intermediate care to nursing homes from January 2012 to January 2014.
MMRI-R scoring was done prior to discharge and subsequent deaths were ascertained.
The MMRI-R tool is a 10-item score sheet with yes/no options, weighted points for each item and scoring guidance .
It uses easily available clinical data, which are a standard part of hospital clinical assessment.
The first eight items are admission to nursing home in the last 3 months, unintentional weight loss, renal failure, chronic heart failure, poor appetite, male sex, dehydration and shortness of breath .
Kaplan–Meier curves were plotted with scores stratified by the cutpoint. By the end of follow-up, 99 patients (54.1%) were dead.The Minimum Data Set (MDS) Mortality Risk Index—Revised (MMRI-R), a simplification of the original MDS Mortality Risk Index (MMRI), was designed, and validated in the USA using information from the MDS, a clinical and administrative database designed to monitor quality of care in Medicare and Medicaid registered nursing homes [10, 11].It predicts 6-month mortality in US nursing home residents, and has not been formally validated in the UK .A proportion of such patients will be in the last few months of life.National recommendations suggest that people approaching the end of life should have an agreed care plan .
Results: a total of 183 patients were followed up for a median of 230 days. The Hosmer–Lemeshow test showed -values of 0.4406 for 3-month and 0.8904 for 6-month mortality.