Abstract
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. (c) 2020 Elsevier Inc. All rights reserved.
Original language | English |
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Pages (from-to) | 1-12 |
Number of pages | 12 |
Journal | Journal of Clinical Epidemiology |
Volume | 130 |
DOIs | |
Publication status | Published - 1 Feb 2021 |
Keywords
- community
- drug burden index
- elderly
- functional status
- important difference
- missing-indicator method
- multimorbidity
- outcomes
- patient-centered care
- people
- performance
- polypharmacy
- primary-care
- prognostic model
- quality of life
- validation
- version
- PERFORMANCE
- Functional status
- Polypharmacy
- COMMUNITY
- Patient-centered care
- Prognostic model
- DRUG BURDEN INDEX
- VALIDATION
- MISSING-INDICATOR METHOD
- Multimorbidity
- Quality of life
- IMPORTANT DIFFERENCE
- PRIMARY-CARE
- VERSION
- PEOPLE
- OUTCOMES
- Elderly