TY - JOUR
T1 - A prognostic model predicted deterioration in health-related quality of life in older patients with multimorbidity and polypharmacy
AU - González-González, Ana I.
AU - Meid, Andreas D.
AU - Dinh, Truc S.
AU - Blom, Jeanet W.
AU - van den Akker, Marjan
AU - Elders, Petra J.M.
AU - Thiem, Ulrich
AU - De Gaudry, Daniela Küllenberg
AU - Swart, Karin M.A.
AU - Rudolf, Henrik
AU - Bosch-Lenders, Donna
AU - Trampisch, Hans Joachim
AU - Meerpohl, Joerg J.
AU - Gerlach, Ferdinand M.
AU - Flaig, Benno
AU - Kom, Ghainsom
AU - Snell, Kym I.E.
AU - Perera, Rafael
AU - Haefeli, Walter E.
AU - Glasziou, Paul P.
AU - Muth, Christiane
N1 - Funding Information: Funding: This work was supported by the German Innovation Funds in accordance with § 92a (2) Volume V of the Social Insurance Code (§ 92a Abs. 2, SGB V—Fünftes Buch Sozialgesetzbuch), grant number: 01VSF16018. The funding body did not play any role in the design of the study, the collection, analysis and interpretation of data, and in writing the manuscript. Andreas D. Meid is funded by the Physician-Scientist Program of Heidelberg University , Faculty of Medicine. Rafael Perera receives funding from the NIHR Oxford Biomedical Research Council (BRC), the NIHR Oxford MedTech and In-Vitro Diagnostics Co-operative (MIC), the NIHR Applied Research Collaboration (ARC) Oxford and Thames Valley, and the Oxford Martin School. Kym Snell is funded by the National Institute for Health Research School for Primary Care (NIHR SPCR Launching Fellowship). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Funding Information: Funding: This work was supported by the German Innovation Funds in accordance with ? 92a (2) Volume V of the Social Insurance Code (? 92a Abs. 2, SGB V?F?nftes Buch Sozialgesetzbuch), grant number: 01VSF16018. The funding body did not play any role in the design of the study, the collection, analysis and interpretation of data, and in writing the manuscript. Andreas D. Meid is funded by the Physician-Scientist Program of Heidelberg University, Faculty of Medicine. Rafael Perera receives funding from the NIHR Oxford Biomedical Research Council (BRC), the NIHR Oxford MedTech and In-Vitro Diagnostics Co-operative (MIC), the NIHR Applied Research Collaboration (ARC) Oxford and Thames Valley, and the Oxford Martin School. Kym Snell is funded by the National Institute for Health Research School for Primary Care (NIHR SPCR Launching Fellowship). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Competing interest: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any additional organizations for the submitted work; no financial relationships over the past 3 years with any organizations that might have an interest in the submitted work; and no other relationships or activities that could have influenced the submitted work. Publisher Copyright: © 2020 Elsevier Inc. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2021/2
Y1 - 2021/2
N2 - Objectives: To develop and validate a prognostic model to predict deterioration in health-related quality of life (dHRQoL) in older general practice patients with at least one chronic condition and one chronic prescription. Study Design and Setting: We used individual participant data from five cluster-randomized trials conducted in the Netherlands and Germany to predict dHRQoL, defined as a decrease in EQ-5D-3 L index score of ≥5% after 6-month follow-up in logistic regression models with stratified intercepts to account for between-study heterogeneity. The model was validated internally and by using internal–external cross-validation (IECV). Results: In 3,582 patients with complete data, of whom 1,046 (29.2%) showed deterioration in HRQoL, and 12/87 variables were selected that were related to single (chronic) conditions, inappropriate medication, medication underuse, functional status, well-being, and HRQoL. Bootstrap internal validation showed a C-statistic of 0.71 (0.69 to 0.72) and a calibration slope of 0.88 (0.78 to 0.98). In the IECV loop, the model provided a pooled C-statistic of 0.68 (0.65 to 0.70) and calibration-in-the-large of 0 (−0.13 to 0.13). HRQoL/functionality had the strongest prognostic value. Conclusion: The model performed well in terms of discrimination, calibration, and generalizability and might help clinicians identify older patients at high risk of dHRQoL. Registration: PROSPERO ID: CRD42018088129.
AB - Objectives: To develop and validate a prognostic model to predict deterioration in health-related quality of life (dHRQoL) in older general practice patients with at least one chronic condition and one chronic prescription. Study Design and Setting: We used individual participant data from five cluster-randomized trials conducted in the Netherlands and Germany to predict dHRQoL, defined as a decrease in EQ-5D-3 L index score of ≥5% after 6-month follow-up in logistic regression models with stratified intercepts to account for between-study heterogeneity. The model was validated internally and by using internal–external cross-validation (IECV). Results: In 3,582 patients with complete data, of whom 1,046 (29.2%) showed deterioration in HRQoL, and 12/87 variables were selected that were related to single (chronic) conditions, inappropriate medication, medication underuse, functional status, well-being, and HRQoL. Bootstrap internal validation showed a C-statistic of 0.71 (0.69 to 0.72) and a calibration slope of 0.88 (0.78 to 0.98). In the IECV loop, the model provided a pooled C-statistic of 0.68 (0.65 to 0.70) and calibration-in-the-large of 0 (−0.13 to 0.13). HRQoL/functionality had the strongest prognostic value. Conclusion: The model performed well in terms of discrimination, calibration, and generalizability and might help clinicians identify older patients at high risk of dHRQoL. Registration: PROSPERO ID: CRD42018088129.
KW - Elderly
KW - Functional status
KW - Multimorbidity
KW - Patient-centered care
KW - Polypharmacy
KW - Prognostic model
KW - Quality of life
UR - http://www.scopus.com/inward/record.url?scp=85095411248&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jclinepi.2020.10.006
DO - https://doi.org/10.1016/j.jclinepi.2020.10.006
M3 - Article
C2 - 33065164
SN - 0895-4356
VL - 130
SP - 1
EP - 12
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
ER -