Pneumonia Mortality Risk Index to Support Discussions of Care Options with Elders

State University Of New York At Buffalo, Buffalo NY

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Abstract

? DESCRIPTION (provided by applicant): Community-acquired pneumonia is a leading cause of hospitalization, admission to the intensive care unit, and subsequent mortality for patients aged 75 years or older. Tragically, death in the intensive care unit (ICU) has been associated with unrelieved symptoms, unmet emotional needs of the patient and family, insufficient shared decision-making, and lower overall quality of life. Evidence-based, scientifically rigorous clinica decision-making is paramount to reducing the rate of avoidable terminal ICU stays through shared decision making for patients with advanced age, frailty, or multiple co-morbid conditions, who may wish to avoid burdensome medical care at, or near, the end of life, if appropriate alternatives are provided. Early palliative care interventions have been demonstrated to be beneficial to the quality of life among selected patients presenting to a hospital. Unfortunately, lack of evidence-based decision making supports, lack of consensus among physicians and nurses and insufficient identification of patients' palliative care needs raise barriers to early involvement of palliative care. Secondly, there is an insufficient supply of palliative care professionals to support shared decision making efforts. Data and tools that help to consistently identify patients with palliative care needs and support in-depth discussions with providers who care for seriously ill patients can be used to help overcome these barriers. Several risk indices are available for physicians and nurses to aid in the prediction of mortality associated with community-acquired pneumonia. However, significant impediments to widespread use persist. Some indices use proprietary scoring algorithms, limiting their availability. Others are cumbersome or difficult to use, necessitating the collection of variables not available in the electronic medical record (EMR). The objective of the proposed investigation is to identify factors predictive of 30-day mortality found in the EMR, among patients 75 years or older at the time of admission to a hospital for pneumonia. The proposed study will utilize EMR data to derive a risk index for mortality that is specific to patients 75 years or older who have community-acquired pneumonia. It is anticipated that this risk index, using data available in the EMR and a simple scoring algorithm, will be easy to use. It will be a valuable case-finding tool to facilitate early and appropriate involvement of palliative care discussions and assist the family and clinical team in its shared decision-making efforts. The case finding tool will help support clinicians, patients, and their families in decision-making about the role of advanced technology in the management of severe illness at, or near, the end of life.