Predicting future functional status for seriously ill hospitalized adults. The SUPPORT prognostic model

A. W. Wu, A. M. Damiano, J. Lynn, C. Alzola, Joan Teno, C. S. Landefeld, N. Desbiens, J. Tsevat, A. Mayer-Oakes, F. E. Harrell, W. A. Knaus

Research output: Contribution to journalArticle

115 Citations (Scopus)

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 severs 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.

Original languageEnglish (US)
Pages (from-to)342-350
Number of pages9
JournalAnnals of internal medicine
Volume122
Issue number5
DOIs
StatePublished - Jan 1 1995
Externally publishedYes

Fingerprint

Activities of Daily Living
Logistic Models
Sickness Impact Profile
ROC Curve
Teaching Hospitals
Hospitalization
Cohort Studies
Quality of Life
Prospective Studies
Interviews
Exercise

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Predicting future functional status for seriously ill hospitalized adults. The SUPPORT prognostic model. / Wu, A. W.; Damiano, A. M.; Lynn, J.; Alzola, C.; Teno, Joan; Landefeld, C. S.; Desbiens, N.; Tsevat, J.; Mayer-Oakes, A.; Harrell, F. E.; Knaus, W. A.

In: Annals of internal medicine, Vol. 122, No. 5, 01.01.1995, p. 342-350.

Research output: Contribution to journalArticle

Wu, AW, Damiano, AM, Lynn, J, Alzola, C, Teno, J, Landefeld, CS, Desbiens, N, Tsevat, J, Mayer-Oakes, A, Harrell, FE & Knaus, WA 1995, 'Predicting future functional status for seriously ill hospitalized adults. The SUPPORT prognostic model', Annals of internal medicine, vol. 122, no. 5, pp. 342-350. https://doi.org/10.7326/0003-4819-122-5-199503010-00004
Wu, A. W. ; Damiano, A. M. ; Lynn, J. ; Alzola, C. ; Teno, Joan ; Landefeld, C. S. ; Desbiens, N. ; Tsevat, J. ; Mayer-Oakes, A. ; Harrell, F. E. ; Knaus, W. A. / Predicting future functional status for seriously ill hospitalized adults. The SUPPORT prognostic model. In: Annals of internal medicine. 1995 ; Vol. 122, No. 5. pp. 342-350.
@article{77afafdb35654ca08698524286a6aa37,
title = "Predicting future functional status for seriously ill hospitalized adults. The SUPPORT prognostic model",
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 severs 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.",
author = "Wu, {A. W.} and Damiano, {A. M.} and J. Lynn and C. Alzola and Joan Teno and Landefeld, {C. S.} and N. Desbiens and J. Tsevat and A. Mayer-Oakes and Harrell, {F. E.} and Knaus, {W. A.}",
year = "1995",
month = "1",
day = "1",
doi = "10.7326/0003-4819-122-5-199503010-00004",
language = "English (US)",
volume = "122",
pages = "342--350",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "5",

}

TY - JOUR

T1 - Predicting future functional status for seriously ill hospitalized adults. The SUPPORT prognostic model

AU - Wu, A. W.

AU - Damiano, A. M.

AU - Lynn, J.

AU - Alzola, C.

AU - Teno, Joan

AU - Landefeld, C. S.

AU - Desbiens, N.

AU - Tsevat, J.

AU - Mayer-Oakes, A.

AU - Harrell, F. E.

AU - Knaus, W. A.

PY - 1995/1/1

Y1 - 1995/1/1

N2 - 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 severs 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.

AB - 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 severs 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.

UR - http://www.scopus.com/inward/record.url?scp=0028899501&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028899501&partnerID=8YFLogxK

U2 - 10.7326/0003-4819-122-5-199503010-00004

DO - 10.7326/0003-4819-122-5-199503010-00004

M3 - Article

C2 - 7847645

AN - SCOPUS:0028899501

VL - 122

SP - 342

EP - 350

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 5

ER -