Can a 5-to-90-day Mortality Predictor Perform Consistently Across Time and Equitably Across Populations?
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| Title: | Can a 5-to-90-day Mortality Predictor Perform Consistently Across Time and Equitably Across Populations? |
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| Authors: | Handler, Jonathan1,2 (AUTHOR) jonathan.a.handler@osfhealthcare.org, Lee, Olivia J.3 (AUTHOR), Chatrath, Sheena3 (AUTHOR), McGarvey, Jeremy4 (AUTHOR), Fitch, Tyler5 (AUTHOR), Jose, Divya6 (AUTHOR), Vozenilek, John3,7,8 (AUTHOR) |
| Source: | Journal of Medical Systems. Dec2023, Vol. 47 Issue 1, p1-10. 10p. |
| Abstract: | Advance care planning (ACP) facilitates end-of-life care, yet many die without it. Timely and accurate mortality prediction may encourage ACP. However, performance of predictors typically differs among sub-populations (e.g., rural vs. urban) and worsens over time (“concept drift”). Therefore, we assessed performance equity and consistency for a novel 5-to-90-day mortality predictor across various demographies, geographies, and timeframes (n = 76,812 total encounters). Predictions were made for the first day of included adult inpatient admissions on a retrospective dataset. AUC-PR remained at 29% both pre-COVID (throughout 2018) and during COVID (8 months in 2021). Pre-COVID-19 recall and precision were 58% and 25% respectively at the 12.5% certainty cutoff, and 12% and 44% at the 37.5% cutoff. During COVID-19, recall and precision were 59% and 26% at the 12.5% cutoff, and 11% and 43% at the 37.5% cutoff. Pre-COVID, compared to the overall population, recall was lower at the 12.5% cutoff in the White, non-Hispanic subgroup and at both cutoffs in the rural subgroup. During COVID-19, precision at the 12.5% cutoff was lower than that of the overall population for the non-White and non-White female subgroups. No other significant differences were seen between subgroups and the corresponding overall population. Overall performance during COVID was unchanged from pre-pandemic performance. Although some comparisons (especially precision at the 37.5% cutoff) were underpowered, precision at the 12.5% cutoff was equitable across most demographies, regardless of the pandemic. Mortality prediction to prioritize ACP conversations can be provided consistently and equitably across many studied timeframes and sub-populations. [ABSTRACT FROM AUTHOR] |
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| Database: | Engineering Source |
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