A prognostic model predicted deterioration in health-related quality of life in older patients with multimorbidity and polypharmacy

A.I. Gonzalez-Gonzalez*, A.D. Meid, T.S. Dinh, J.W. Blom, M. van den Akker, P.J.M. Elders, U. Thiem, D.K. De Gaudry, K.M.A. Swart, H. Rudolf, D. Bosch-Lenders, H.J. Trampisch, J.J. Meerpohl, F.M. Gerlach, B. Flaig, G. Kom, K.I.E. Snell, R. Perera, W.E. Haefeli, P.P. GlasziouC. Muth

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Web of Science)

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 languageEnglish
Pages (from-to)1-12
Number of pages12
JournalJournal of Clinical Epidemiology
Volume130
DOIs
Publication statusPublished - 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

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