Comparing the predictive ability of the Revised Minimum Dataset Mortality Risk Index (MMRI-R) with nurses’ predictions of mortality among frail older people:a cohort study

Cole, Andy, Arthur, Antony and Seymour, Jane (2019) Comparing the predictive ability of the Revised Minimum Dataset Mortality Risk Index (MMRI-R) with nurses’ predictions of mortality among frail older people:a cohort study. Age and Ageing, 48 (3). 394–400. ISSN 0002-0729

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Abstract

Objectives To establish the accuracy of community nurses’ predictions of mortality among older people with multiple long-term conditions, to compare these with a mortality rating index and to assess the incremental value of nurses’ predictions to the prognostic tool. Design A prospective cohort study using questionnaires to gather clinical information about patients case managed by community nurses. Nurses estimated likelihood of mortality for each patient on a 5point rating scale. The dataset was randomly split into derivation and validation cohorts. Cox proportional hazard models were used to estimate risk equations for the MMRI-R and nurses’ predictions of mortality individually and combined. Measures of discrimination and calibration were calculated and compared within the validation cohort. Setting Two NHS Trusts in England providing case-management services by nurses for frail older people with multiple long-term conditions. Participants 867 patients on the caseload of 35 case-management nurses. 433 and 434 patients were assigned to the derivation and validation cohorts respectively. Patients were followed up for 12 months. Results 249 patients died (28.72%). In the validation cohort MMRI-R demonstrated good discrimination (Harrell’s c-index 0.71) and nurses’ predictions similar discrimination (Harrell’s c-index 0.70). There was no evidence of superiority in performance of either method individually (p=0.83) but the MMRIR and nurses’ predictions together were superior to nurses’ predictions alone (p=0.01). Conclusions Patient mortality is associated with higher MMRI-R scores and nurses’ predictions of 12-month mortality. The MMRI-R enhanced nurses’ predictions and may improve nurses’ confidence in initiating anticipatory care interventions.

Item Type: Article
Faculty \ School: Faculty of Medicine and Health Sciences > School of Health Sciences
Depositing User: LivePure Connector
Date Deposited: 09 Jan 2019 12:30
Last Modified: 18 Mar 2020 02:25
URI: https://ueaeprints.uea.ac.uk/id/eprint/69500
DOI: 10.1093/ageing/afz011

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