Risk Evaluation for Support: Predicting Elder Life in the Community Tool (RESPECT)

Completed

• Conditions: Death
• Interventions: Procedure: Home Care/RAI-HC Assessment

• Registration Number: NCT02779309
• Lead Sponsor: Ottawa Hospital Research Institute

Brief Summary

To develop a mortality risk prediction model that can be applied to the wide spectrum of risks that are seen in the home care setting.

Detailed Description

ABSTRACT

Introduction: Older adults living in the community often have multiple, chronic conditions and functional impairments. A challenge for healthcare providers working in the community is the lack of a predictive tool that can be applied to the broad spectrum of mortality risks observed and may be used to inform care planning.

Objective: To develop a mortality risk prediction model for older adults in the home care setting. The final algorithm will be implemented as a web-based calculator that can be used by older adults needing care, as well as their informal and formal caregivers.

Design: Open cohort study using the Resident Assessment Instrument for Home Care (RAI-HC) data in Ontario, Canada, from January 1, 2007, to December 31, 2013.

Participants: The derivation cohort will consist of approximately 437 000 home care recipients from January 1, 2007, to December 31, 2012. A split sample validation cohort will include approximately 122 000 recipients from January 1 to December 31, 2013.

Main outcome measures: Predicted survival from the time of an RAI-HC assessment. All deaths (N ≈ 245 000) will be ascertained through linkage to the provincial vital statistics records.

Statistical analysis: Proportional hazards regression will be estimated after assessment of assumptions. Predictors will include sociodemographic characteristics, social support, health conditions, functional status, cognition, symptoms of decline, and prior healthcare use. Model performance will be evaluated for 6- and 12-month predicted risks, including measures of calibration (e.g., calibration plots) and discrimination (e.g., c-statistics). The final algorithm will be generated by combining development and validation data.

Study Timeline

• Study Start: 2007-01
• Primary Completion: 2013-12
• Study First Submitted: 2016-05-18
• Study First Submitted QC: 2016-05-19
• Study First Posted: 2016-05-20
• Study Completion: 2017-12
• Status Verified: 2018-05
• Last Update Submitted: 2018-05-08
• Last Update Posted: 2018-05-09

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 486000

Inclusion Criteria

• Have received a structured RAI-HC assessment
• Between 50 and 105 years of age

Exclusion Criteria

• Not eligible for Ontario's universal health insurance program (OHIP)
• Did not receive a structured RAI-HC assessment

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Validation Cohort	Home Care/RAI-HC Assessment	122,000 home care recipients who received services from January 1, 2013 to December 31, 2013.
Development Cohort	Home Care/RAI-HC Assessment	437,000 home care recipients who received services from January 1, 2007 to December 31, 2012.

Primary Outcome Measures

Name	Time	Method
6-month Mortality	6 months	Mortality status at 6 months after receiving a structured Resident Assessment Instrument for Home Care (RAI-HC) Assessment.

Secondary Outcome Measures

Name	Time	Method
12-month Mortality	12 months	Mortality status at 12 months after receiving a structured Resident Assessment Instrument for Home Care (RAI-HC) Assessment.