A study protocol for the development of a multivariable model predicting 6- and 12-month mortality for people with dementia living in residential aged care facilities (RACFs) in Australia
Abstract Background For residential aged care facility (RACF) residents with dementia, lack of prognostic guidance presents a significant challenge for end of life care planning. In an attempt to address this issue, models have been developed to assess mortality risk for people with advanced dementi...
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| Format: | Article |
| Language: | English |
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BMC
2020-10-01
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| Series: | Diagnostic and Prognostic Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s41512-020-00085-0 |
| _version_ | 1818384652139757568 |
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| author | Ross Bicknell Wen Kwang Lim Andrea B. Maier Dina LoGiuidice |
| author_facet | Ross Bicknell Wen Kwang Lim Andrea B. Maier Dina LoGiuidice |
| author_sort | Ross Bicknell |
| collection | DOAJ |
| description | Abstract Background For residential aged care facility (RACF) residents with dementia, lack of prognostic guidance presents a significant challenge for end of life care planning. In an attempt to address this issue, models have been developed to assess mortality risk for people with advanced dementia, predominantly using long-term care minimum data set (MDS) information from the USA. A limitation of these models is that the information contained within the MDS used for model development was not collected for the purpose of identifying prognostic factors. The models developed using MDS data have had relatively modest ability to discriminate mortality risk and are difficult to apply outside the MDS setting. This study will aim to develop a model to estimate 6- and 12-month mortality risk for people with dementia from prognostic indicators recorded during usual clinical care provided in RACFs in Australia. Methods A secondary analysis will be conducted for a cohort of people with dementia from RACFs participating in a cluster-randomized trial of a palliative care education intervention (IMPETUS-D). Ten prognostic indicator variables were identified based on a literature review of clinical features associated with increased mortality for people with dementia living in RACFs. Variables will be extracted from RACF files at baseline and mortality measured at 6 and 12 months after baseline data collection. A multivariable logistic regression model will be developed for 6- and 12-month mortality outcome measures using backwards elimination with a fractional polynomial approach for continuous variables. Internal validation will be undertaken using bootstrapping methods. Discrimination of the model for 6- and 12-month mortality will be presented as receiver operating curves with c statistics. Calibration curves will be presented comparing observed and predicted event rates for each decile of risk as well as flexible calibration curves derived using loess-based functions. Discussion The model developed in this study aims to improve clinical assessment of mortality risk for people with dementia living in RACFs in Australia. Further external validation in different populations will be required before the model could be developed into a tool to assist with clinical decision-making in the future. |
| first_indexed | 2024-12-14T03:25:40Z |
| format | Article |
| id | doaj.art-1fa06646bb204f72b3decd1c693ee12a |
| institution | Directory Open Access Journal |
| issn | 2397-7523 |
| language | English |
| last_indexed | 2024-12-14T03:25:40Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Diagnostic and Prognostic Research |
| spelling | doaj.art-1fa06646bb204f72b3decd1c693ee12a2022-12-21T23:18:52ZengBMCDiagnostic and Prognostic Research2397-75232020-10-01411810.1186/s41512-020-00085-0A study protocol for the development of a multivariable model predicting 6- and 12-month mortality for people with dementia living in residential aged care facilities (RACFs) in AustraliaRoss Bicknell0Wen Kwang Lim1Andrea B. Maier2Dina LoGiuidice3Department of Medicine and Aged Care, @AgeMelbourne, Melbourne Health–Royal Melbourne Hospital, University of MelbourneDepartment of Medicine and Aged Care, @AgeMelbourne, Melbourne Health–Royal Melbourne Hospital, University of MelbourneDepartment of Medicine and Aged Care, @AgeMelbourne, Melbourne Health–Royal Melbourne Hospital, University of MelbourneDepartment of Medicine and Aged Care, @AgeMelbourne, Melbourne Health–Royal Melbourne Hospital, University of MelbourneAbstract Background For residential aged care facility (RACF) residents with dementia, lack of prognostic guidance presents a significant challenge for end of life care planning. In an attempt to address this issue, models have been developed to assess mortality risk for people with advanced dementia, predominantly using long-term care minimum data set (MDS) information from the USA. A limitation of these models is that the information contained within the MDS used for model development was not collected for the purpose of identifying prognostic factors. The models developed using MDS data have had relatively modest ability to discriminate mortality risk and are difficult to apply outside the MDS setting. This study will aim to develop a model to estimate 6- and 12-month mortality risk for people with dementia from prognostic indicators recorded during usual clinical care provided in RACFs in Australia. Methods A secondary analysis will be conducted for a cohort of people with dementia from RACFs participating in a cluster-randomized trial of a palliative care education intervention (IMPETUS-D). Ten prognostic indicator variables were identified based on a literature review of clinical features associated with increased mortality for people with dementia living in RACFs. Variables will be extracted from RACF files at baseline and mortality measured at 6 and 12 months after baseline data collection. A multivariable logistic regression model will be developed for 6- and 12-month mortality outcome measures using backwards elimination with a fractional polynomial approach for continuous variables. Internal validation will be undertaken using bootstrapping methods. Discrimination of the model for 6- and 12-month mortality will be presented as receiver operating curves with c statistics. Calibration curves will be presented comparing observed and predicted event rates for each decile of risk as well as flexible calibration curves derived using loess-based functions. Discussion The model developed in this study aims to improve clinical assessment of mortality risk for people with dementia living in RACFs in Australia. Further external validation in different populations will be required before the model could be developed into a tool to assist with clinical decision-making in the future.http://link.springer.com/article/10.1186/s41512-020-00085-0DementiaMortalityPrognosisPredictive modelingResidential aged careLong-term care |
| spellingShingle | Ross Bicknell Wen Kwang Lim Andrea B. Maier Dina LoGiuidice A study protocol for the development of a multivariable model predicting 6- and 12-month mortality for people with dementia living in residential aged care facilities (RACFs) in Australia Diagnostic and Prognostic Research Dementia Mortality Prognosis Predictive modeling Residential aged care Long-term care |
| title | A study protocol for the development of a multivariable model predicting 6- and 12-month mortality for people with dementia living in residential aged care facilities (RACFs) in Australia |
| title_full | A study protocol for the development of a multivariable model predicting 6- and 12-month mortality for people with dementia living in residential aged care facilities (RACFs) in Australia |
| title_fullStr | A study protocol for the development of a multivariable model predicting 6- and 12-month mortality for people with dementia living in residential aged care facilities (RACFs) in Australia |
| title_full_unstemmed | A study protocol for the development of a multivariable model predicting 6- and 12-month mortality for people with dementia living in residential aged care facilities (RACFs) in Australia |
| title_short | A study protocol for the development of a multivariable model predicting 6- and 12-month mortality for people with dementia living in residential aged care facilities (RACFs) in Australia |
| title_sort | study protocol for the development of a multivariable model predicting 6 and 12 month mortality for people with dementia living in residential aged care facilities racfs in australia |
| topic | Dementia Mortality Prognosis Predictive modeling Residential aged care Long-term care |
| url | http://link.springer.com/article/10.1186/s41512-020-00085-0 |
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