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Algorithm for predicting death among older adults in the home care setting: study protocol for the Risk Evaluation for Support: Predictions for Elder-life in the Community Tool (RESPECT)
  1. Amy T Hsu1,2,3,
  2. Douglas G Manuel1,2,3,
  3. Monica Taljaard1,3,
  4. Mathieu Chalifoux2,
  5. Carol Bennett1,2,
  6. Andrew P Costa4,
  7. Susan Bronskill5,6,7,
  8. Daniel Kobewka1,3,8,
  9. Peter Tanuseputro1,9
  1. 1Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  2. 2ICES uOttawa, Institute for Clinical Evaluative Sciences (ICES), Ottawa, Ontario, Canada
  3. 3Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
  4. 4Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
  5. 5Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  6. 6Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  7. 7Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario Canada
  8. 8Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada
  9. 9Bruyère Research Institute, Ottawa, Ontario, Canada
  1. Correspondence to Dr Amy T Hsu; ahsu{at}


Introduction Older adults living in the community often have multiple, chronic conditions and functional impairments. A challenge for healthcare providers working in the community is the lack of a predictive tool that can be applied to the broad spectrum of mortality risks observed and may be used to inform care planning.

Objective To predict survival time for older adults in the home care setting. The final mortality risk algorithm will be implemented as a web-based calculator that can be used by older adults needing care and by their caregivers.

Design Open cohort study using the Resident Assessment Instrument for Home Care (RAI-HC) data in Ontario, Canada, from 1 January 2007 to 31 December 2013.

Participants The derivation cohort will consist of ∼437 000 older adults who had an RAI-HC assessment between 1 January 2007 and 31 December 2012. A split sample validation cohort will include ∼122 000 older adults with an RAI-HC assessment between 1 January and 31 December 2013.

Main outcome measures Predicted survival from the time of an RAI-HC assessment. All deaths (n≈245 000) will be ascertained through linkage to a population-based registry that is maintained by the Ministry of Health in Ontario.

Statistical analysis Proportional hazards regression will be estimated after assessment of assumptions. Predictors will include sociodemographic factors, social support, health conditions, functional status, cognition, symptoms of decline and prior healthcare use. Model performance will be evaluated for 6-month and 12-month predicted risks, including measures of calibration (eg, calibration plots) and discrimination (eg, c-statistics). The final algorithm will use combined development and validation data.

Ethics and dissemination Research ethics approval has been granted by the Sunnybrook Health Sciences Centre Review Board. Findings will be disseminated through presentations at conferences and in peer-reviewed journals.

Trial registration number NCT02779309, Pre-results.

  • Advance care planning
  • Survival analysis
  • Clinical prediction rule
  • Frail older adults
  • Mortality
  • Home care

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors ATH and DGM were responsible for drafting the manuscript, the study design, protocol development and revising the manuscript prior to submission. MT and CB contributed to the design of this study, the proposed analytical plan and provided critical reviews of the intellectual content presented. MC was involved in the protocol development and provided data/statistical support. APC, DK and SB provided content expertise and critical reviews of the intellectual content presented. PT is the lead investigator of the study and was responsible for the conception of the project, the grant application, study design, protocol development and editorial inputs for the manuscript. All authors have reviewed the manuscript and approved the final version.

  • Funding This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results and conclusions reported in this paper are those of the authors and are independent of the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of CIHI.

  • Competing interests None declared.

  • Ethics approval Research ethics approval has been granted by the Sunnybrook Health Sciences Centre Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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