Performance of electronic medical record tool in predicting 6-month mortality in hospitalized patients with cancer

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of hospital medicine Pub Date : 2025-02-17 DOI:10.1002/jhm.70012

Nita S. Kulkarni MD, Matthew P. Landler MD, Elaine R. Cohen MEd, Diane B. Wayne MD, Eytan Szmuilowicz MD

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引用次数: 0

Abstract

Background

A systematic tool to identify hospitalized patients with high mortality risk may be beneficial for targeting palliative care to those in greatest need.

Objective

Evaluate the performance of the End-of-life Index (EOLI; Epic Systems Corporation) in identifying patients at the highest 6-month mortality risk among hospitalized patients with cancer.

Methods

We conducted a retrospective study of adults with cancer admitted to oncology services in a 959-bed hospital between July 1 and December 31, 2023. We evaluated EOLI score performance in determining mortality risk using the area under the receiver operating characteristic curve (AUC). The primary outcome was 6-month mortality for patients with an EOLI score above and below the optimal threshold value. Secondary outcomes included in-hospital mortality, 30-day mortality, length of stay, intensive care unit (ICU) utilization, palliative care consultation, do-not-resuscitate status on discharge, and discharge disposition.

Results

The EOLI score had moderate accuracy in identifying patients at higher risk of 6-month mortality (AUC: 0.71) with an optimal threshold value of 40. For patients with EOLI > 40 and < 40, the 6-month mortality was 45.9% and 16.3%, respectively (p < .001). Patients with EOLI > 40 had higher ICU utilization (12.4% vs. 6.5%, p = .002) and were more likely to be discharged to a location other than home (13.5% vs. 5.3%; p < .001).

Conclusions

For hospitalized patients with cancer, the EOLI shows moderate accuracy in identifying patients with a high risk of 6-month mortality. As a screening tool, the EOLI can be used to identify patients who may benefit from timely palliative care.

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电子病历工具在预测癌症住院患者6个月死亡率中的应用

背景：一个系统的工具来识别住院患者的高死亡率的风险可能有利于针对那些最需要姑息治疗。目的：评价生命末期指数（EOLI）的表现；Epic Systems Corporation)在确定住院癌症患者中6个月死亡风险最高的患者方面的研究。方法：我们对2023年7月1日至12月31日期间在一家959张床位的医院接受肿瘤服务的成人癌症患者进行了回顾性研究。我们使用受试者工作特征曲线下面积（AUC）来评估EOLI评分在确定死亡风险方面的表现。主要结局是EOLI评分高于或低于最佳阈值的患者的6个月死亡率。次要结局包括住院死亡率、30天死亡率、住院时间、重症监护病房（ICU）使用率、姑息治疗咨询、出院时不复苏状态和出院处置。结果：EOLI评分在识别6个月死亡风险较高的患者方面具有中等准确性（AUC: 0.71），最佳阈值为40。对于EOLI bb0 40和< 40的患者，6个月死亡率分别为45.9%和16.3% (p 40的患者ICU使用率较高（12.4%对6.5%,p = 0.002），并且更有可能出院到家庭以外的地方(13.5%对5.3%；p结论：对于住院癌症患者，EOLI在识别6个月死亡率高风险患者方面显示中等准确性。作为一种筛查工具，EOLI可用于识别可能受益于及时姑息治疗的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of hospital medicine 医学-医学：内科

CiteScore

4.40

自引率

11.50%

发文量

233

审稿时长

4-8 weeks

期刊介绍： JHM is a peer-reviewed publication of the Society of Hospital Medicine and is published 12 times per year. JHM publishes manuscripts that address the care of hospitalized adults or children. Broad areas of interest include (1) Treatments for common inpatient conditions; (2) Approaches to improving perioperative care; (3) Improving care for hospitalized patients with geriatric or pediatric vulnerabilities (such as mobility problems, or those with complex longitudinal care); (4) Evaluation of innovative healthcare delivery or educational models; (5) Approaches to improving the quality, safety, and value of healthcare across the acute- and postacute-continuum of care; and (6) Evaluation of policy and payment changes that affect hospital and postacute care.