González-González, AI, Meid, AD, Dinh, TS, Blom, JW, van den Akker, M, Elders, PJ, Thiem, U, De Gaudry, DK, Ma Swart, K, Rudolf, H, Bosch-Lenders, D, Trampisch, H-J, Meerpohl, JJ, Gerlach, FM, Flaig, B, Kom, G, Snell, KIE ORCID: https://orcid.org/0000-0001-9373-6591, Perera, R, Haefeli, WE, Glasziou, PP and Muth, C (2020) A prognostic model predicted deterioration in health-related quality of life in older patients with multimorbidity and polypharmacy. Journal of Clinical Epidemiology.

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JCE_2020_309_Revised and accepted version.docx - Accepted Version
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Abstract

OBJECTIVE: To develop and validate a prognostic model to predict deterioration in health-related quality of life (dHRQoL) in older general practice patients with at least one chronic condition and one chronic prescription. STUDY DESIGN AND SETTING: We used individual participant data from five cluster-randomized trials conducted in the Netherlands and Germany to predict dHRQoL, defined as a decrease in EQ-5D-3L index score of ≥5 % after six-month follow-up in logistic regression models with stratified intercepts to account for between-study heterogeneity. The model was validated internally, and by using internal-external cross-validation (IECV). RESULTS: - In 3,582 patients with complete data, of whom 1,046 (29.2 %) showed deterioration in HRQoL, 12/87 variables were selected that were related to single (chronic) conditions, inappropriate medication, medication underuse, functional status, well-being and HRQoL. Bootstrap internal validation showed a C-statistic of 0.71 (0.69 to 0.72), and a calibration slope of 0.88 (0.78 to 0.98). In the IECV loop, the model provided a pooled C-statistic of 0.68 (0.65 to 0.70) and calibration-in-the-large of 0 (-0.13 to 0.13). HRQoL/functionality had the strongest prognostic value. CONCLUSION: - The model performed well in terms of discrimination, calibration, and generalizability and might help clinicians identify older patients at high-risk of dHRQoL. REGISTRATION: PROSPERO ID: CRD42018088129.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at https://doi.org/10.1016/j.jclinepi.2020.10.006 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Multimorbidity, elderly, functional status, patient-centred care, polypharmacy, prognostic model, quality of life
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC952 Geriatrics
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Related URLs:
Depositing User: Symplectic
Date Deposited: 04 Nov 2020 10:51
Last Modified: 21 Nov 2020 13:03
URI: https://eprints.keele.ac.uk/id/eprint/8871

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