Lindsay Yourman and colleagues have a paper in JAMA this week reviewing prognostic indices for older adults.
Even more interesting, this team of colleagues from UCSF has developed an on-line tool, ePrognosis that provides a simple way to enter patient information into 16 predictive tools and receive a predicted life span based on the entered characteristics. The entry portal on the web site provides a list of different indices arrayed by time frame of the assessment tool, and the quality of the tool as assessed in the paper published in JAMA. Shown below are the community based mortality indices available; 16 different indices are available, some based on transitions such as hospitalization or nursing home admission. The size of the bubbles are driven by how often each index is used on ePrognosis, as well as by the degree to which users rated the tool as useful.
For example, I used the Porock score which provides a prediction of 6 month mortality risk of institutionalized persons and is often used to inform hospice eligibility decisions, entered information for a fictitious patient and it returned the following:
A predicted 69% chance of mortality within 6 months is returned. As ePrognosis notes, this is only a tool, and it is most meaningfully used by a physician/health care team that knows a patient. However, this tool appears to be a major opportunity to make evidence-based prognostication available to busy clinicians and is a very interesting development in the field of geriatrics and palliative care.
As an accompanying editorial notes, prognostic information is often not fully considered or used in making treatment and screening decisions (should you continue routine mammogram given prognosis for CHF, for example?). ePrognosis could help mainstream the provision of objective prognostic information. This seems like a very important paper and dissemination tool to me.
Lindsey C. Yourman, MD;Sei J. Lee, MD, MAS; Mara A. Schonberg, MD, MPH; Eric W. Widera, MD; Alexander K. Smith, MD, MS, MPH. Prognostic Indices for Older Adults: A Systematic Review. JAMA. 2012;307(2):182-192.