Eliminating the Surprise Question Leaves Home Care Providers With Few Options for Identifying Mortality Risk.
Suzanne S Sullivan, Sabrina Casucci, Chin-Shang Li
PMID 31808348WHAT IT FOUND
In 69,097 older adults starting home care, nurses' and therapists' risk ratings tracked death at 12 and 24 months.
Daily living scores agreed only weakly with those ratings, so removing that rating leaves no simple substitute.
Key findings
01Older adults rated likely to remain fragile or die had about a 35% probability of dying at 12 months and about 45% at 24 months, compared with about 10% and 20% for those rated stable or temporary risk.
02ADL total scores split patients into lower-risk and higher-risk clusters at a cutoff of 15, but the clusters agreed only weakly with the risk rating and with 24-month survival.
03The higher-dependence ADL cluster was reported as more often not alive at 24 months, 46.7% versus 26.8%, although the article also gives 15.7% versus 10.9% for the same comparison.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The sample was limited to people aged 65 and older admitted to home care in January 2012. OASIS-C data were used to simulate OASIS-D because OASIS-D was not yet available for population-level analysis. The ADL total score showed only weak agreement with the OASIS-SQ and with 24-month survival. Some OASIS items have poor validity and reliability, which limits research use of the assessment. The article reports two different 24-month mortality percentages for the ADL clusters, 46.7% and 15.7% for the higher-dependence cluster, so that cluster's mortality estimate is unclear.
Declared interests
The authors report no conflicts of interest.
The easy way to misread this
Do not treat the ADL total score as a reliable substitute for the removed OASIS-SQ. Its agreement with the risk question and with 24-month survival was weak, kappa = 0.20 and kappa = 0.17, so it does not identify mortality risk on its own.