Objectives
- 1.Identify hospitalized patients at high risk of death in one year.
- 2.Apply the CARING criteria to patients on hospital admission.
Background. The CARING criteria, which accurately predict death at 1 year among hospitalized veterans, have not been validated in other patient populations. Identifying patients at high risk for 1-year mortality at the time of hospital admission provides clinicians with a unique opportunity to consider palliative care interventions for these patients during hospitalization.
Research objectives. Validate the CARING criteria among general medical and surgical patients at a tertiary academic center.
Methods. Retrospective cohort study of all admissions to the general medicine and surgical services of the University of Colorado Hospital from July 2005 through August 2005 (n = 427). Medical records were reviewed for demographic information and presence of the CARING criteria (C = primary diagnosis of cancer, A = Admit more than two times in the past year for a chronic medical condition, R = resident in a nursing home, I = ICU with multi-organ failure, NG = NHPCO non-cancer hospice guidelines). Only information available at the time of admission was used to determine the CARING criteria. Mortality data came from vital records. Logistic regression models were fit for 1-year mortality predicted by the four dichotomous CARING variables (excluding ICU) and age by quartile.
Results. One hundred and sixty-one (37.7%) patients met at least one of the CARING criteria and 77 (18%) patients died during the 1-year follow-up period. The validation sample differed from the original CARING sample with more females (50% versus 2%) and younger age (mean age 54 versus 63 years). Logistic regression odds ratios with 95% CI: Cancer = 4.0 (CI, 2.2-7.4); Admit = 1.3 (CI, 0.7-2.4); Resident = 1.6 (CI, 0.5-5.0); NHPCO guidelines = 6.0 (CI, 2.3–15.9). These findings are quantitatively similar to the original CARING logistic regression model.
Conclusion. The CARING criteria maintain statistical validity in a more broadly representative patient population.
Implications for research, policy, or practice. The CARING criteria should be considered as a simple mnemonic tool to identify patients on hospital admission who may benefit from palliative care.
Domain
Structure and Processes of Care
Article info
Footnotes
(All speakers for this session have disclosed no relevant financial relationships.)
Identification
Copyright
© 2011 Published by Elsevier Inc.
