Development and internal validation of prognostic models to predict negative health outcomes in older patients with multimorbidity and polypharmacy in general practice
dc.contributor.author | Müller, BS | |
dc.contributor.author | Uhlmann, L | |
dc.contributor.author | Ihle, P | |
dc.contributor.author | Stock, C | |
dc.contributor.author | von Buedingen, F | |
dc.contributor.author | Beyer, M | |
dc.contributor.author | Gerlach, FM | |
dc.contributor.author | Perera, R | |
dc.contributor.author | Valderas, JM | |
dc.contributor.author | Glasziou, P | |
dc.contributor.author | van den Akker, M | |
dc.contributor.author | Muth, C | |
dc.date.accessioned | 2020-10-28T15:30:22Z | |
dc.date.issued | 2020-10-22 | |
dc.description.abstract | Background Polypharmacy interventions are resource-intensive and should be targeted to those at risk of negative health outcomes. Our aim was to develop and internally validate prognostic models to predict health-related quality of life (HRQoL) and the combined outcome of falls, hospitalisation, institutionalisation and nursing care needs, in older patients with multimorbidity and polypharmacy in general practices. Methods Design: two independent data sets, one comprising health insurance claims data (n=592 456), the other data from the PRIoritising MUltimedication in Multimorbidity (PRIMUM) cluster randomised controlled trial (n=502). Population: ≥60 years, ≥5 drugs, ≥3 chronic diseases, excluding dementia. Outcomes: combined outcome of falls, hospitalisation, institutionalisation and nursing care needs (after 6, 9 and 24 months) (claims data); and HRQoL (after 6 and 9 months) (trial data). Predictor variables in both data sets: age, sex, morbidity-related variables (disease count), medication-related variables (European Union-Potentially Inappropriate Medication list (EU-PIM list)) and health service utilisation. Predictor variables exclusively in trial data: additional socio-demographics, morbidity-related variables (Cumulative Illness Rating Scale, depression), Medication Appropriateness Index (MAI), lifestyle, functional status and HRQoL (EuroQol EQ-5D-3L). Analysis: mixed regression models, combined with stepwise variable selection, 10-fold cross validation and sensitivity analyses. Results Most important predictors of EQ-5D-3L at 6 months in best model (Nagelkerke’s R² 0.507) were depressive symptoms (−2.73 (95% CI: −3.56 to −1.91)), MAI (−0.39 (95% CI: −0.7 to −0.08)), baseline EQ-5D-3L (0.55 (95% CI: 0.47 to 0.64)). Models based on claims data and those predicting long-term outcomes based on both data sets produced low R² values. In claims data-based model with highest explanatory power (R²=0.16), previous falls/fall-related injuries, previous hospitalisations, age, number of involved physicians and disease count were most important predictor variables. Conclusions Best trial data-based model predicted HRQoL after 6 months well and included parameters of well-being not found in claims. Performance of claims data-based models and models predicting long-term outcomes was relatively weak. For generalisability, future studies should refit models by considering parameters representing well-being and functional status. | en_GB |
dc.description.sponsorship | Techniker Krankenkasse (German Statutory Healthcare Insurance Company) | en_GB |
dc.identifier.citation | Vol. 10, article e039747 | en_GB |
dc.identifier.doi | 10.1136/bmjopen-2020-039747 | |
dc.identifier.uri | http://hdl.handle.net/10871/123396 | |
dc.language.iso | en | en_GB |
dc.publisher | BMJ Publishing Group | en_GB |
dc.rights | © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. | en_GB |
dc.title | Development and internal validation of prognostic models to predict negative health outcomes in older patients with multimorbidity and polypharmacy in general practice | en_GB |
dc.type | Article | en_GB |
dc.date.available | 2020-10-28T15:30:22Z | |
dc.identifier.issn | 2044-6055 | |
dc.description | This is the final version. Available on open access from BMJ Publishing Group via the DOI in this record | en_GB |
dc.identifier.journal | BMJ Open | en_GB |
dc.rights.uri | https://creativecommons.org/licenses/by-nc/4.0/ | en_GB |
dcterms.dateAccepted | 2020-10-02 | |
rioxxterms.version | VoR | en_GB |
rioxxterms.licenseref.startdate | 2020-10-02 | |
rioxxterms.type | Journal Article/Review | en_GB |
refterms.dateFCD | 2020-10-28T15:25:58Z | |
refterms.versionFCD | VoR | |
refterms.dateFOA | 2020-10-28T15:30:26Z | |
refterms.panel | A | en_GB |
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Except where otherwise noted, this item's licence is described as © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.