NEW HAVEN, CT — March 12, 2002 — In order to foster sound health care programs and policies concerning an aging population, a Yale researcher has devised a new index that forecasts which patients are most likely to die within one year after being discharged from the hospital.
"It's very important to be able to compare how sick patients are across populations, across hospitals and across studies," said Sharon Inouye, M.D., associate professor of internal medicine and geriatrics at Yale School of Medicine and senior author of the study published this month in the Journal of the American Geriatrics Society. "Any time we are looking at the outcome of treatment and quality of care, it all impinges on understanding how comparable patients are."
What she and her co-researchers found were that elderly patients with 10 conditions were at higher risk for dying within one year of being hospitalized. Those conditions, in descending order of risk, are: congestive heart failure; pneumonia; chronic lung disease; solid tumor cancer that is localized; metastatic cancer; lymphoma/leukemia; major stroke; acute renal failure; chronic renal failure, and diabetes with end organ damage.
The study included 524 patients 70 and older with a comparison group of 852 patients of the same age who also were hospitalized. The researchers first identified 16 high risk medical diagnoses for older patients, based on a review of medical literature and expert opinion. The experts added six more diagnoses. From this group, the 10 final diagnoses were selected.
Dr. Inouye cautioned that the risk assessment is not for use with individuals.
"Given the potential for misuse, or misinterpretation, we do not advocate use of this index at the bedside for individual patients," she said. "The index is recommended for mortality prediction in patient groups or populations."