Skip Navigation Skip To Footer

Patient-Centered Outcomes Prognostication (PCOP)...

Overview Results & Impact
Patient-Centered Outcomes Prognostication (PCOP) Study

Project Lead

MD, MSHP

Michael Detsky

Overview

Clinicians' predictions about their patients’ recovery prospects can be a valuable part of shared-decision making with patients and families. However, clinicians often hesitate to provide these predictions or prognoses given their lack of certainty. Moreover, the accuracy of these predictions had yet to be vigorously studied. We assessed ICU physicians’ and nurses’ binary predictions of in-hospital mortality for more than 300 critically ill patients across five University of Pennsylvania Health System intensive care units, as well as their prognostic judgments of patients' abilities to return to their homes, walk up 10 stairs, communicate clearly, and toilet independently six months after ICU admission. Clinicians also rated their confidence in their predictions using a 5-point Likert scale.

Sponsors

  • Otto Haas Charitable Trust

Study Status

Dissemination

Results & Impact

Physicians' and nurses' predictions of 6-month outcomes for critically ill patients varied, depending on what outcome was being predicted, whether physicians and nurses were confident and whether they were concordant in their predictions. Overall, predictions were most accurately predicted for 6-month survival (positive likelihood ratio (LR), 5.91 [95% CI 3.74-9.32], negative LR 0.41 [95% CI 0.33-0.52]) and toileting (positive LR, 6.00 [95% CI 3.18-11.30], negative LR 0.51 [95% CI 0.35-0.75]) . When physicians and nurses were confident, their predictive accuracy improved, and when they were both confident and agreed, there predictive accuracy was even better (positive LR, 40.35 [95% CI, 5.73-284.28], negative LR, 0.18 [95% CI, 0.06- 0.50] ) and toileting (positive LR, 15.75 [95% CI, 4.04-58.94]; negative LR, 0.11 [95% CI, 0.02-0.68]). Further work is being done to better understand how clinicians arrive at prognostic judgments and to understand what clinician factors make them more accurate predictors.

 

 

 

Detsky ME, Harhay MO, Bayard DF, Delman AM, Buehler AE, Kent SA, Ciuffetelli IV, Cooney E, Gabler NB, Ratcliffe SJ, Mikkelsen ME, Halpern SD. Discriminative Accuracy of Physician and Nurse Predictions for Survival and Functional Outcomes 6 Months After an ICU Admission. JAMA. 2017;317(21):2187–2195.

figure 1 panel b lrneginverted
figure 1 panel b lrneginverted

Related Publications

Discriminative Accuracy of Physician and Nurse Predictions for Survival and Functional Outcomes 6 Months After an ICU Admission.
Mark Mikkelsen Scott Halpern Michael Harhay Elizabeth Cooney-Zingman

Discriminative Accuracy of Physician and Nurse Predictions for Survival and Functional Outcomes 6 Months After an ICU Admission.

Clinician behavior, Acute care health services research
Page 1 Created with Sketch.

We generate high-quality evidence to advance healthcare policies and practices that improve the lives of all people affected by serious illness.

Website designed & built by P'unk Avenue