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

Ana I González-González, Andreas D Meid, Truc S Dinh, Jeanet W Blom, Marjan van den Akker, Petra Jm Elders, Ulrich Thiem, Daniela Küllenberg De Gaudry, Karin Ma Swart, Henrik Rudolf, Donna Bosch-Lenders, Hans-Joachim Trampisch, Joerg J Meerpohl, Ferdinand M Gerlach, Benno Flaig, Ghainsom Kom, Kym Ie Snell, Rafael Perera, Walter E Haefeli, Paul P GlasziouChristiane Muth

Research output: Contribution to journalArticleResearchpeer-review

Abstract

OBJECTIVE: 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-3L index score of ≥5 % after six-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, 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.

Original languageEnglish
JournalJournal of Clinical Epidemiology
DOIs
Publication statusE-pub ahead of print - 13 Oct 2020

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