Role of a multidimensional prognosis in-hospital monitoring for older patients with prolonged stay.

Abstract

The Multidimensional Prognostic Index (MPI) is a prognostic tool-amongst others-validated for mortality, length of hospital stay (LHS) and rehospitalisation risk assessment. Like theComprehensive Geriatric Assessment (CGA), the MPI is usually obtained at hospital admission and discharge, not during the hospital stay. The aim of the present study was to address the role ofan additional CGA-based MPI measurement during hospitalisation as an indicator of "real-time" in-hospital changes. Two-hundred consecutive multimorbid patients (128 M, 72 F, median age 75 (78-82)) admitted to an internal medicine ward of a German metropolitan university hospital prospectively underwent a CGA and a prognosis calculation using the MPI on admission and discharge. Seven to 10days later, an intermediate assessment (IA) was performed for patients needinga longer stay. The median LHS was 10 (6-19) days. As expected, patients who received an IA had poorer prognosis as measured by higher MPI values (P=.037) and a worse functional status at admission than patients who had a shorter stay (P=.025). In case of prolonged hospitalisation, significant changes in the MPI were detected between admission and IA, both in terms of improvement and deterioration (P<.001). Different overtime courses were observed during prolonged hospitalisation according to the severity of prognosis (P<.001). A CGA-based MPI evaluation during hospitalisation can be used as an objective instrument to detect changes in multidimensional health course. Prompt identification of the latter may enable quick tailored interventions to ensure overall better outcomes at and after discharge.