Predicting Future Functional Status for Seriously Ill Hospitalized Adults: The SUPPORT Prognostic Model

  1. Albert W. Wu, MD, MPH;
  2. Anne M. Damiano, MD, MA;
  3. Joanne Lynn, MS;
  4. Carlos Alzola, MS;
  5. Joan Teno, MD, MS;
  6. C. Seth Landefeld, MD;
  7. Norman Desbiens, MD;
  8. Joel Tsevat, MD, PhD;
  9. Alison Mayer-Oakes, MD;
  10. Frank E. Harrell, PhD; and
  11. William A. Knaus, MD
  1. From Johns Hopkins University, Baltimore, Maryland. Dartmouth Medical School, Hanover, New Hampshire. Duke University Medical Center, Durham, North Carolina. Case Western Reserve University School of Medicine, Cleveland, Ohio. Marshfield Medical Research Foundation, Marshfield, Wisconsin. Beth Israel Hospital, Boston, Massachusetts. The University of California, Los Angeles, School of Medicine. The George Washington University Medical Center, Washington, D.C. Requests for Reprints: Albert W. Wu, MD, MPH, Health Services Research and Development Center, the Johns Hopkins University, 624 North Broadway, Baltimore, MD 21205-1901. Disclaimer: The opinions and findings contained in this article are those of the authors and do not necessarily represent the views of the Robert Wood Johnson Foundation or their Board of Trustees. Acknowledgments: The authors thank the late Marilyn Bergner, PhD, for her contributions to this study. She inspired our efforts to assess and improve the health status of patients. Grant Support: In part by the Robert Wood Johnson Foundation.

    Abstract

    Objective: To develop a model estimating the probability of an adult patient having severe functional limitations 2 months after being hospitalized with one of nine serious illnesses.

    Design: Prospective cohort study.

    Setting: Five teaching hospitals in the United States.

    Participants: 1746 patients (model development) who survived 2 months and completed an interview, selected from 4301 patients in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT); independent validation sample of 2478 patients.

    Measurements and Main Outcomes: Patient function 2 months after admission categorized as absence or presence of severe functional limitations (defined as Sickness Impact Profile scores ≥ 30 or as activities of daily living scores ≥ 4 [levels that require near-constant personal assistance]). A logistic regression model was constructed to predict severe functional limitation.

    Results: One third (n = 590) of patients who were interviewed at 2 months had severe functional limitations. Changes in functional status were common: Of those with no baseline dependencies (not dependent on personal assistance), 21% were severely limited at 2 months; of those with 4 or more baseline limitations, 30% had improved. The patient's ability to do activities of daily living was the most important predictor of functional status. Physiologic abnormalities, diagnosis, days in hospital, age, quality of life, and previous exercise capacity also contributed substantially. Model performance, assessed using receiver-operating characteristic curves, was 0.79 for the development sample and 0.75 for the validation sample. The model was well calibrated for the entire risk range.

    Conclusions: Functional outcome varied substantially after hospitalization for a serious illness. A small amount of readily available clinical information can estimate the probability of severe functional limitations.

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    1. Ann Intern Med March 1, 1995 vol. 122 no. 5 342-350
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