It is feasible to flag 'near end-of-life' status in older patients from routine general practice data

Magnolia Cardona; Margaret Williamson; Mark Jones; Danielle Ní Chróinín; John Gullotta; Ken Hillman; Ebony T Lewis; Mark Morgan

doi:10.31128/AJGP-08-19-5033

It is feasible to flag 'near end-of-life' status in older patients from routine general practice data

Magnolia Cardona
, Margaret Williamson
, Mark Jones
, Danielle Ní Chróinín
, John Gullotta
, Ken Hillman
, Ebony T Lewis
, Mark Morgan

Research output: Contribution to journal › Article › Research › peer-review

Abstract

Background

Prognostic uncertainty delays discussions and leads to unnecessary treatments for older patients who are dying. The aim of this study was to investigate the feasibility of using routinely collected data from MedicineInsight, a large Australian general practice database, to flag indicators of near end-of-life (nEOL) in patients aged ≥75 years and evaluate their association with death over 12 months.

Methods

A retrospective chart review was used to assess the feasibility of identifying these indicators in the data (160,897 patients from 464 practices across Australia). Conditional logistic regression was used to assess the independent contribution of nEOL indicators in patients aged 75–84 and ≥85 years using a case-control design matching by practice.

Results

The strongest indicators for nEOL status were advanced malignancy, residential aged care, nutritional vulnerability, anaemia, cognitive impairment and heart failure. Other indicators included hospital attendance, pneumonia, decubitus ulcer, chronic obstructive pulmonary disease, antipsychotic prescription, male sex and stroke.

DiscussionConsideration of routinely collected patient data may suggest nEOL status and trigger advance care planning discussions.

Original language	English
Pages (from-to)	752-758
Number of pages	7
Journal	Australian Journal of General Practice
Volume	49
Issue number	11
DOIs	https://doi.org/10.31128/AJGP-08-19-5033
Publication status	Published - Nov 2020

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@article{48a99425343843abae663dfa0d8c025c,

title = "It is feasible to flag 'near end-of-life' status in older patients from routine general practice data",

abstract = "BackgroundPrognostic uncertainty delays discussions and leads to unnecessary treatments for older patients who are dying. The aim of this study was to investigate the feasibility of using routinely collected data from MedicineInsight, a large Australian general practice database, to flag indicators of near end-of-life (nEOL) in patients aged ≥75 years and evaluate their association with death over 12 months.MethodsA retrospective chart review was used to assess the feasibility of identifying these indicators in the data (160,897 patients from 464 practices across Australia). Conditional logistic regression was used to assess the independent contribution of nEOL indicators in patients aged 75–84 and ≥85 years using a case-control design matching by practice.ResultsThe strongest indicators for nEOL status were advanced malignancy, residential aged care, nutritional vulnerability, anaemia, cognitive impairment and heart failure. Other indicators included hospital attendance, pneumonia, decubitus ulcer, chronic obstructive pulmonary disease, antipsychotic prescription, male sex and stroke.DiscussionConsideration of routinely collected patient data may suggest nEOL status and trigger advance care planning discussions.",

author = "Magnolia Cardona and Margaret Williamson and Mark Jones and \{N{\'i} Chr{\'o}in{\'i}n\}, Danielle and John Gullotta and Ken Hillman and Lewis, \{Ebony T\} and Mark Morgan",

year = "2020",

month = nov,

doi = "10.31128/AJGP-08-19-5033",

language = "English",

volume = "49",

pages = "752--758",

journal = "Australian Journal of General Practice",

issn = "2208-7958",

publisher = "Royal Australian College of General Practitioners",

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T1 - It is feasible to flag 'near end-of-life' status in older patients from routine general practice data

AU - Cardona, Magnolia

AU - Williamson, Margaret

AU - Jones, Mark

AU - Ní Chróinín, Danielle

AU - Gullotta, John

AU - Hillman, Ken

AU - Lewis, Ebony T

AU - Morgan, Mark

PY - 2020/11

Y1 - 2020/11

N2 - BackgroundPrognostic uncertainty delays discussions and leads to unnecessary treatments for older patients who are dying. The aim of this study was to investigate the feasibility of using routinely collected data from MedicineInsight, a large Australian general practice database, to flag indicators of near end-of-life (nEOL) in patients aged ≥75 years and evaluate their association with death over 12 months.MethodsA retrospective chart review was used to assess the feasibility of identifying these indicators in the data (160,897 patients from 464 practices across Australia). Conditional logistic regression was used to assess the independent contribution of nEOL indicators in patients aged 75–84 and ≥85 years using a case-control design matching by practice.ResultsThe strongest indicators for nEOL status were advanced malignancy, residential aged care, nutritional vulnerability, anaemia, cognitive impairment and heart failure. Other indicators included hospital attendance, pneumonia, decubitus ulcer, chronic obstructive pulmonary disease, antipsychotic prescription, male sex and stroke.DiscussionConsideration of routinely collected patient data may suggest nEOL status and trigger advance care planning discussions.

AB - BackgroundPrognostic uncertainty delays discussions and leads to unnecessary treatments for older patients who are dying. The aim of this study was to investigate the feasibility of using routinely collected data from MedicineInsight, a large Australian general practice database, to flag indicators of near end-of-life (nEOL) in patients aged ≥75 years and evaluate their association with death over 12 months.MethodsA retrospective chart review was used to assess the feasibility of identifying these indicators in the data (160,897 patients from 464 practices across Australia). Conditional logistic regression was used to assess the independent contribution of nEOL indicators in patients aged 75–84 and ≥85 years using a case-control design matching by practice.ResultsThe strongest indicators for nEOL status were advanced malignancy, residential aged care, nutritional vulnerability, anaemia, cognitive impairment and heart failure. Other indicators included hospital attendance, pneumonia, decubitus ulcer, chronic obstructive pulmonary disease, antipsychotic prescription, male sex and stroke.DiscussionConsideration of routinely collected patient data may suggest nEOL status and trigger advance care planning discussions.

UR - https://www.scopus.com/pages/publications/85094935293

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DO - 10.31128/AJGP-08-19-5033

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C2 - 33123717

SN - 2208-7958

VL - 49

SP - 752

EP - 758

JO - Australian Journal of General Practice

JF - Australian Journal of General Practice

IS - 11

ER -

It is feasible to flag 'near end-of-life' status in older patients from routine general practice data

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