Title

The interRAI CHESS Scale is Comparable to the Palliative Performance Scale in Predicting 90-day Mortality in a Palliative Home Care Population

Authors

Nicole Williams, Wilfrid Laurier UniversityFollow
Kirsten Hermans, University of Brussels and Ghent University
Joachim Cohen, University of Brussels and Ghent University
Anja Declercq, KU Leuven
Ahmed Jakda, McMaster University School of Medicine
James Downar, University of Ottawa Faculty of Medicine
Dawn M. Guthrie, Wilfrid Laurier UniversityFollow
John P. Hirdes, University of Waterloo

Document Type

Article

Publication Date

2022

Department

Department of Kinesiology and Physical Education

Abstract

Background: Prognostic accuracy is important throughout all stages of the illness trajectory as it has implications for the timing of important conversations and decisions around care. Physicians often tend to over-estimate prognosis and may under-recognize palliative care (PC) needs. It is therefore essential that all relevant stakeholders have as much information available to them as possible when estimating prognosis.

Aims: The current study examined whether the interRAI Changes in Health, End-Stage Disease, Signs and Symptoms (CHESS) Scale is a good predictor of mortality in a known PC population and to see how it compares to the Palliative Performance Scale (PPS) in predicting 90-day mortality.

Methods: This retrospective cohort study used data from 2011 to 2018 on 80,261 unique individuals receiving palliative home care and assessed with both the interRAI Palliative Care instrument and the PPS. Logistic regression models were used to evaluate the relationship between the main outcome, 90-day mortality and were then replicated for a secondary outcome examining the number of nursing visits. Comparison of survival time was examined using Kaplan-Meier survival curves.

Results: The CHESS Scale was an acceptable predictor of 90-day mortality (c-statistic = 0.68; p < 0.0001) and was associated with the number of nursing days (c = 0.61; p < 0.0001) and had comparable performance to the PPS (c = 0.69; p < 0.0001). The CHESS Scale performed slightly better than the PPS in predicting 90-day mortality when combined with other interRAI PC items (c = 0.72; p < 0.0001).

Conclusion: The interRAI CHESS Scale is an additional decision-support tool available to clinicians that can be used alongside the PPS when estimating prognosis. This additional information can assist with the development of care plans, discussions, and referrals to specialist PC teams.

Comments

Published in BMC Palliative Care 2022, under a CC BY 4.0 license.

Recommended Citation

Williams N, Hermans K, Cohen J, Declercq A, Jakda A, Downar J, Guthrie DM, Hirdes JP. The interRAI CHESS Scale is comparable to the Palliative Performance Scale in predicting 90-day mortality in a palliative home care population. BMC Palliative Care 2022; 21:174. doi: doi.org/10.1186/s12904-022-01059-3.