PREDICTING FUTURE FUNCTIONAL STATUS FOR SERIOUSLY ILL HOSPITALIZED ADULTS - THE SUPPORT PROGNOSTIC MODEL

Objective: To develop a model estimating the probability of an adult p atient having severe functional limitations 2 months after being hospi talized with one of nine serious illnesses. Design: Prospective cohort study. Setting: Five teaching hospitals in the United States. Partici pants: 1746 patients (model development) who survived 2 months and com pleted an interview, selected from 4301 patients in the Study to Under stand 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 categori zed as absence or presence of severe functional limitations (defined a s Sickness Impact Profile scores greater than or equal to 30 or as act ivities of daily living scores greater than or equal to 4 [levels that require near-constant personal assistance]). A logistic regression mo del was constructed to predict severe functional limitation. Results: One third (n = 590) of patients who were interviewed at 2 months had s evere functional limitations. Changes in functional status were common : Of those with no baseline dependencies (not dependent on personal as sistance), 21% were severely limited at 2 months; of those with 4 or m ore baseline limitations, 30% had improved. The patient's ability to d o activities of daily living was the most important predictor of funct ional status. Physiologic abnormalities, diagnosis, days in hospital, age, quality of life, and previous exercise capacity also contributed substantially. Model performance, assessed using receiver-operating ch aracteristic curves, was 0.79 for the development sample and 0.75 for the validation sample. The model was well calibrated for the entire ri sk range. Conclusions: Functional outcome varied substantially after h ospitalization for a serious illness. A small amount of readily availa ble clinical information can estimate the probability of severe functi onal limitations.