External validation of the Hospital-patient One-year Mortality Risk (HOMR) model for predicting death within 1 year after hospital admission

van Walraven, Carl; McAlister, Finlay A; Bakal, Jeffrey A; Hawken, Steven; Donzé, Jacques (2015). External validation of the Hospital-patient One-year Mortality Risk (HOMR) model for predicting death within 1 year after hospital admission. CMAJ, 187(10), pp. 725-733. Canadian Medical Association 10.1503/cmaj.150209

[img] Text
725.full.pdf - Published Version
Restricted to registered users only
Available under License Publisher holds Copyright.

Download (247kB) | Request a copy

BACKGROUND

Predicting long-term survival after admission to hospital is helpful for clinical, administrative and research purposes. The Hospital-patient One-year Mortality Risk (HOMR) model was derived and internally validated to predict the risk of death within 1 year after admission. We conducted an external validation of the model in a large multicentre study.

METHODS

We used administrative data for all nonpsychiatric admissions of adult patients to hospitals in the provinces of Ontario (2003-2010) and Alberta (2011-2012), and to the Brigham and Women's Hospital in Boston (2010-2012) to calculate each patient's HOMR score at admission. The HOMR score is based on a set of parameters that captures patient demographics, health burden and severity of acute illness. We determined patient status (alive or dead) 1 year after admission using population-based registries.

RESULTS

The 3 validation cohorts (n = 2,862,996 in Ontario, 210 595 in Alberta and 66,683 in Boston) were distinct from each other and from the derivation cohort. The overall risk of death within 1 year after admission was 8.7% (95% confidence interval [CI] 8.7% to 8.8%). The HOMR score was strongly and significantly associated with risk of death in all populations and was highly discriminative, with a C statistic ranging from 0.89 (95% CI 0.87 to 0.91) to 0.92 (95% CI 0.91 to 0.92). Observed and expected outcome risks were similar (median absolute difference in percent dying in 1 yr 0.3%, interquartile range 0.05%-2.5%).

INTERPRETATION

The HOMR score, calculated using routinely collected administrative data, accurately predicted the risk of death among adult patients within 1 year after admission to hospital for nonpsychiatric indications. Similar performance was seen when the score was used in geographically and temporally diverse populations. The HOMR model can be used for risk adjustment in analyses of health administrative data to predict long-term survival among hospital patients.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Donzé, Jacques

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0820-3946

Publisher:

Canadian Medical Association

Language:

English

Submitter:

Jacques Donzé

Date Deposited:

23 Mar 2016 10:58

Last Modified:

06 Jul 2017 14:04

Publisher DOI:

10.1503/cmaj.150209

PubMed ID:

26054605

BORIS DOI:

10.7892/boris.77318

URI:

https://boris.unibe.ch/id/eprint/77318

Actions (login required)

Edit item Edit item
Provide Feedback