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The MDS-CHESS scale: a new measure to predict mortality in institutionalized older people
John P Hirdes1, Dinnus H Frijters, Gary F Teare
1Department of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, Canada. hirdes@uwaterloo.ca
Objectives:
To develop a scale predicting mortality and other adverse outcomes associated with frailty.
Design:
Observational study based on Minimum Data Set (MDS) 2.0 and mortality data.
Setting:
Ontario chronic hospitals.
Participants:
All chronic hospital patients (N = 28,495) assessed with the MDS 2.0 after mandatory implementation in July 1996 followed until May 1999.
Measurements:
MDS 2.0 assessments done as part of normal practice mainly by registered nurses or multidisciplinary teams in a chronic hospital. Mortality data are available from the accompanying discharge tracking form.
Results:
The MDS-Changes in Health, End-stage disease and Symptoms and Signs (CHESS) score is a composite measure addressing changes in health, end-stage disease, and symptoms and signs of medical problems. It is a strong predictor of mortality (P <.0001) independent of the effects of age, sex, activities of daily living impairment, cognition, and do-not-resuscitate orders. It is also strongly associated with physician activity, complex medical procedures, and pain (P <.001 for each dependent variable).
Conclusions:
The CHESS score provides a useful new MDS-based test to predict mortality and to measure instability in health as a clinical outcome.
Insights
A new scale, the Minimum Data Set-Changes in Health, End-stage disease and Symptoms and Signs (CHESS) score, effectively predicts mortality in chronic hospital patients. This frailty assessment tool also identifies adverse health outcomes.
Area of Science:
- Gerontology and Geriatric Medicine
- Health Services Research
- Clinical Informatics
Background:
- Frailty is a significant predictor of adverse outcomes in older adults.
- Existing assessment tools may not fully capture the dynamic nature of patient health status.
- There is a need for a validated, easily administered scale to predict mortality and health instability.
Purpose of the Study:
- To develop and validate the Minimum Data Set-Changes in Health, End-stage disease and Symptoms and Signs (MDS-CHESS) score.
- To assess the predictive accuracy of the MDS-CHESS score for mortality and other adverse outcomes in chronic hospital patients.
Main Methods:
- An observational study utilizing Minimum Data Set (MDS) 2.0 assessments and mortality data from 28,495 chronic hospital patients in Ontario.
- MDS 2.0 assessments were conducted as part of routine clinical practice by nurses or multidisciplinary teams.
- Mortality data were obtained from discharge tracking forms, with follow-up until May 1999.
Main Results:
- The MDS-CHESS score, a composite measure of health changes, end-stage disease, and symptoms, strongly predicted mortality (P <.0001).
- The score's predictive power for mortality was independent of age, sex, functional status, cognition, and do-not-resuscitate orders.
- MDS-CHESS was also significantly associated with physician activity, complex medical procedures, and pain (P <.001).
Conclusions:
- The MDS-CHESS score is a valuable, MDS-based tool for predicting mortality in chronic hospital settings.
- The score effectively measures health instability as a clinical outcome.
- This scale offers a novel approach to identifying high-risk patients and informing clinical decision-making.