Development of a Risk Tool to Support Discussions of Care for Older Adults Admitted to the ICU With Pneumonia

Background:Early, data-driven discussion surrounding palliative care can improve care delivery and patient experience.Objective:To develop a 30-day mortality prediction tool for older patients in intensive care unit (ICU) with pneumonia that will initiate palliative care earlier in hospital course.Design:Retrospective Electronic Health Record (EHR) review.Setting:Four urban and suburban hospitals in a Western New York hospital system.Participants:A total of 1237 consecutive patients (>75 years) admitted to the ICU with pneumonia from July 2011 to December 2014.Measurements:Data abstracted included demographics, insurance type, comorbidities, and clinical factors. Thirty-day mortality was also determined. Logistic regression identified predictors of 30-day mortality. Area under the receiver operating curve (ROC) was calculated to quantify the degree to which the model accurately classified participants. Using the coordinates of the ROC, a predicted probability was identified to indicate high risk.Results:A...