@article{e249f97a874f4dc8b1ac93d48037c8a7,
title = "A prognostic model predicted deterioration in health-related quality of life in older patients with multimorbidity and polypharmacy",
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.",
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",
author = "A.I. Gonzalez-Gonzalez and A.D. Meid and T.S. Dinh and J.W. Blom and \{van den Akker\}, M. and P.J.M. Elders and U. Thiem and \{De Gaudry\}, D.K. and K.M.A. Swart and H. Rudolf and D. Bosch-Lenders and H.J. Trampisch and J.J. Meerpohl and F.M. Gerlach and B. Flaig and G. Kom and K.I.E. Snell and R. Perera and W.E. Haefeli and P.P. Glasziou and C. Muth",
note = "Funding Information: Funding: This work was supported by the German Innovation Funds in accordance with § 92a (2) Volume V of the Social Insurance Code (§ 92a Abs. 2, SGB V—F{\"u}nftes Buch Sozialgesetzbuch), grant number: 01VSF16018. The funding body did not play any role in the design of the study, the collection, analysis and interpretation of data, and in writing the manuscript. Andreas D. Meid is funded by the Physician-Scientist Program of Heidelberg University , Faculty of Medicine. Rafael Perera receives funding from the NIHR Oxford Biomedical Research Council (BRC), the NIHR Oxford MedTech and In-Vitro Diagnostics Co-operative (MIC), the NIHR Applied Research Collaboration (ARC) Oxford and Thames Valley, and the Oxford Martin School. Kym Snell is funded by the National Institute for Health Research School for Primary Care (NIHR SPCR Launching Fellowship). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Funding Information: Funding: This work was supported by the German Innovation Funds in accordance with ? 92a (2) Volume V of the Social Insurance Code (? 92a Abs. 2, SGB V?F?nftes Buch Sozialgesetzbuch), grant number: 01VSF16018. The funding body did not play any role in the design of the study, the collection, analysis and interpretation of data, and in writing the manuscript. Andreas D. Meid is funded by the Physician-Scientist Program of Heidelberg University, Faculty of Medicine. Rafael Perera receives funding from the NIHR Oxford Biomedical Research Council (BRC), the NIHR Oxford MedTech and In-Vitro Diagnostics Co-operative (MIC), the NIHR Applied Research Collaboration (ARC) Oxford and Thames Valley, and the Oxford Martin School. Kym Snell is funded by the National Institute for Health Research School for Primary Care (NIHR SPCR Launching Fellowship). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health. Competing interest: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi\_disclosure.pdf and declare: no support from any additional organizations for the submitted work; no financial relationships over the past 3 years with any organizations that might have an interest in the submitted work; and no other relationships or activities that could have influenced the submitted work. Publisher Copyright: {\textcopyright} 2020 Elsevier Inc.",
year = "2021",
month = feb,
day = "1",
doi = "10.1016/j.jclinepi.2020.10.006",
language = "English",
volume = "130",
pages = "1--12",
journal = "Journal of Clinical Epidemiology",
issn = "0895-4356",
publisher = "Elsevier Inc.",
}