Mueller, Beate S., Uhlmann, Lorenz, Ihle, Peter, Stock, Christian, von Buedingen, Fiona, Beyer, Martin, Gerlach, Ferdinand M., Perera, Rafael, Valderas, Jose Maria, Glasziou, Paul ORCID: 0000-0001-7564-073X, van den Akker, Marjan and Muth, Christiane (2020). Development and internal validation of prognostic models to predict negative health outcomes in older patients with multimorbidity and polypharmacy in general practice. BMJ Open, 10 (10). LONDON: BMJ PUBLISHING GROUP. ISSN 2044-6055

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Abstract

Background Polypharmacy interventions are resource-intensive and should be targeted to those at risk of negative health outcomes. Our aim was to develop and internally validate prognostic models to predict health-related quality of life (HRQoL) and the combined outcome of falls, hospitalisation, institutionalisation and nursing care needs, in older patients with multimorbidity and polypharmacy in general practices. Methods Design: two independent data sets, one comprising health insurance claims data (n=592 456), the other data from the PRIoritising MUltimedication in Multimorbidity (PRIMUM) cluster randomised controlled trial (n=502). Population: >= 60 years, >= 5 drugs, >= 3 chronic diseases, excluding dementia. Outcomes: combined outcome of falls, hospitalisation, institutionalisation and nursing care needs (after 6, 9 and 24 months) (claims data); and HRQoL (after 6 and 9 months) (trial data). Predictor variables in both data sets: age, sex, morbidity-related variables (disease count), medication-related variables (European Union-Potentially Inappropriate Medication list (EU-PIM list)) and health service utilisation. Predictor variables exclusively in trial data: additional socio-demographics, morbidity-related variables (Cumulative Illness Rating Scale, depression), Medication Appropriateness Index (MAI), lifestyle, functional status and HRQoL (EuroQol EQ-5D-3L). Analysis: mixed regression models, combined with stepwise variable selection, 10-fold cross validation and sensitivity analyses. Results Most important predictors of EQ-5D-3L at 6 months in best model (Nagelkerke's R-2 0.507) were depressive symptoms (-2.73 (95% CI: -3.56 to -1.91)), MAI (-0.39 (95% CI: -0.7 to -0.08)), baseline EQ-5D-3L (0.55 (95% CI: 0.47 to 0.64)). Models based on claims data and those predicting long-term outcomes based on both data sets produced low R-2 values. In claims data-based model with highest explanatory power (R-2=0.16), previous falls/fall-related injuries, previous hospitalisations, age, number of involved physicians and disease count were most important predictor variables. Conclusions Best trial data-based model predicted HRQoL after 6 months well and included parameters of well-being not found in claims. Performance of claims data-based models and models predicting long-term outcomes was relatively weak. For generalisability, future studies should refit models by considering parameters representing well-being and functional status.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Mueller, Beate S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Uhlmann, LorenzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ihle, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stock, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
von Buedingen, FionaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Beyer, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gerlach, Ferdinand M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Perera, RafaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Valderas, Jose MariaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Glasziou, PaulUNSPECIFIEDorcid.org/0000-0001-7564-073XUNSPECIFIED
van den Akker, MarjanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muth, ChristianeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-349665
DOI: 10.1136/bmjopen-2020-039747
Journal or Publication Title: BMJ Open
Volume: 10
Number: 10
Date: 2020
Publisher: BMJ PUBLISHING GROUP
Place of Publication: LONDON
ISSN: 2044-6055
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
POTENTIALLY INAPPROPRIATE MEDICATIONS; ANTICHOLINERGIC RISK SCALES; CHRONIC DISEASES; ELDERLY-PATIENTS; END-POINTS; PEOPLE; BURDEN; RECOMMENDATIONS; ASSOCIATIONS; ADMISSIONMultiple languages
Medicine, General & InternalMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/34966

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