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Validation of the Patient-Reported Outcome Mortality Prediction Tool (PROMPT)
Christine W Duarte1, Adam W Black1, Kimberly Murray1
1Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland; Department of Family Medicine, Maine Medical Center, Portland; Geriatric Medicine, Maine Medical Center, Portland, Maine, USA.
Journal of Pain and Symptom Management
|April 21, 2015
Summary
The Patient-Reported Outcome Mortality Prediction Tool (PROMPT) showed good discrimination but poor calibration in elderly patients. Updating the PROMPT improved its accuracy and clinical utility for advance care planning.
Area of Science:
- Geriatrics
- Health Services Research
- Biostatistics
Background:
- The Patient-Reported Outcome Mortality Prediction Tool (PROMPT) estimates 6-month mortality risk in elderly patients with declining health.
- External validation of the PROMPT in diverse populations is lacking.
Purpose of the Study:
- To prospectively validate the PROMPT in an independent patient cohort.
- To explore the clinical utility of the PROMPT.
Main Methods:
- A diverse cohort of 467 patients aged 65+ was studied.
- Model calibration and discrimination were assessed and updated.
- Clinical utility was examined using decision curve analysis.
Main Results:
- The validation cohort had lower mortality (6.9%) than the derivation cohort (15.0%).
- Discrimination remained good (AUC 0.73), but calibration was poor.
- Updating the PROMPT significantly improved calibration and demonstrated clinical utility for advance care planning.
Conclusions:
- The PROMPT requires external validation and model updating for improved calibration in heterogeneous populations.
- An updated PROMPT demonstrated potential clinical utility for initiating advance care planning.
- The tool showed good discrimination but needed calibration improvements.
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