A prognostic model predicted deterioration in health-related quality of life in older patients with multimorbidity and polypharmacy
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...
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| Main Authors: | , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
2021
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| In: |
Journal of clinical epidemiology
Year: 2020, Volume: 130, Pages: 1-12 |
| ISSN: | 1878-5921 |
| DOI: | 10.1016/j.jclinepi.2020.10.006 |
| Online Access: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1016/j.jclinepi.2020.10.006 Verlag, lizenzpflichtig, Volltext: https://www.sciencedirect.com/science/article/pii/S0895435620311458 
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| Author Notes: | Ana I. González-González, Andreas D. Meid, Truc S. Dinh, Jeanet W. Blom, Marjan van den Akker, Petra J.M. Elders, Ulrich Thiem, Daniela Küllenberg De Gaudry, Karin M.A. Swart, Henrik Rudolf, Donna Bosch-Lenders, Hans-Joachim Trampisch, Joerg J. Meerpohl, Ferdinand M. Gerlach, Benno Flaig, Ghainsom Kom, Kym I.E. Snell, Rafael Perera, Walter E. Haefeli, Paul P. Glasziou, Christiane Muth |
| Summary: | 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. |
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| Item Description: | Published online 13 October 2020 Gesehen am 12.05.2021 |
| Physical Description: | Online Resource |
| ISSN: | 1878-5921 |
| DOI: | 10.1016/j.jclinepi.2020.10.006 |