Predicting Those Who Are at Risk of Dying within Six to Twelve Months in Primary Care: A Retrospective Case-Control General Practice Chart Analysis.

Abstract

<b><i>Background:</i></b> With an aging population, and most deaths due to a nonmalignant cause, there is urgency to review the nature of end-of-life care (EoLC) to minimize gaps in service provision. Early introduction of EoLC benefits patient and carers, so identification of those at risk of dying 6 to 12 months before death is highly desirable. <b><i>Objective:</i></b> To identify the most predictive patient characteristics of a risk of death within 6 to 12 months as a precursor to developing a user-friendly primary care screening tool. <b><i>Design:</i></b> Retrospective case-control study. <b><i>Setting/Subjects:</i></b> Australian general practice. Cases were patients aged ≥70 years who died in the previous 5 years. Controls were matched for age and gender. Exclusion criteria were: no available practice records for the 18 months before death (cases) and data collection (controls); no corroborated evidence of death. <b><i>Measurements:</i></b> Supportive and Palliative Care Indicators Tool (SPICT) indicators of deterioration in medical records. <b><i>Results:</i></b> There were 215 deaths and 267 controls. The most predictive patient characteristics of a risk of death within 6 to 12 months are: deteriorating performance status, weight loss, persistent symptoms, request for palliative care or treatment withdrawal, impaired activities of daily living, falls ± fractured hip, neurological deterioration, advanced lung disease, and estimated glomerular filtration rate <30 mL/min/1.73 m² with deteriorating health. Our predictive model has a sensitivity and specificity of 67% and 87%, respectively, with a predictive accuracy of 78%. <b><i>Conclusions:</i></b> This model predicts risk of death within 6 to 12 months with acceptable reliability in a general practice setting and has the potential to be incorporated into clinical practice and electronic records.