Prediction Models for Severe Manifestations and Mortality due to COVID-19: A Rapid Systematic Review

ABSTRACTBackgroundThroughout 2020, the coronavirus disease 2019 (COVID-19) has become a threat to public health on national and global level. There has been an immediate need for research to understand the clinical signs and symptoms of COVID-19 that can help predict deterioration including mechanical ventilation, organ support, and death. Studies thus far have addressed the epidemiology of the disease, common presentations, and susceptibility to acquisition and transmission of the virus; however, an accurate prognostic model for severe manifestations of COVID-19 is still needed because of the limited healthcare resources available.ObjectiveThis systematic review aims to evaluate published reports of prediction models for severe illnesses caused COVID-19.MethodsSearches were developed by the primary author and a medical librarian using an iterative process of gathering and evaluating terms. Comprehensive strategies, including both index and keyword methods, were devised for PubMed and EMBASE. The data of confirmed COVID-19 patients from randomized control studies, cohort studies, and case-control studies published between January 2020 and July 2020 were retrieved. Studies were independently assessed for risk of bias and applicability using the Prediction Model Risk Of Bias Assessment Tool (PROBAST). We collected study type, setting, sample size, type of validation, and outcome including intubation, ventilation, any other type of organ support, or death. The combination of the prediction model, scoring system, performance of predictive models, and geographic locations were summarized.ResultsA primary review found 292 articles relevant based on title and abstract. After further review, 246 were excluded based on the defined inclusion and exclusion criteria. Forty-six articles were included in the qualitative analysis. Inter observer agreement on inclusion was 0.86 (95% confidence interval: 0.79 - 0.93). When the PROBAST tool was applied, 44 of the 46 articles were identified to have high or unclear risk of bias, or high or unclear concern for applicability. Two studied reported prediction models, 4C Mortality Score from hospital data and QCOVID from general public data from UK, and were rated as low risk of bias and low concerns for applicability.ConclusionSeveral prognostic models are reported in the literature, but many of them had concerning risks of biases and applicability. For most of the studies, caution is needed before use, as many of them will require external validation before dissemination. However, two articles were found to have low risk of bias and low applicability can be useful tools.

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Prediction models for diagnosis and prognosis of covid-19: systematic review and critical appraisal

BMJ ◽

10.1136/bmj.m1328 ◽

2020 ◽

pp. m1328 ◽

Cited By ~ 392

Author(s):

Laure Wynants ◽

Ben Van Calster ◽

Gary S Collins ◽

Richard D Riley ◽

Georg Heinze ◽

...

Keyword(s):

Systematic Review ◽

High Risk ◽

General Population ◽

Prediction Model ◽

Critical Appraisal ◽

Prediction Models ◽

Risk Of Bias ◽

Prognostic Models ◽

Link Type ◽

Diagnostic Models

Abstract Objective To review and appraise the validity and usefulness of published and preprint reports of prediction models for diagnosing coronavirus disease 2019 (covid-19) in patients with suspected infection, for prognosis of patients with covid-19, and for detecting people in the general population at increased risk of becoming infected with covid-19 or being admitted to hospital with the disease. Design Living systematic review and critical appraisal by the COVID-PRECISE (Precise Risk Estimation to optimise covid-19 Care for Infected or Suspected patients in diverse sEttings) group. Data sources PubMed and Embase through Ovid, arXiv, medRxiv, and bioRxiv up to 5 May 2020. Study selection Studies that developed or validated a multivariable covid-19 related prediction model. Data extraction At least two authors independently extracted data using the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist; risk of bias was assessed using PROBAST (prediction model risk of bias assessment tool). Results 14 217 titles were screened, and 107 studies describing 145 prediction models were included. The review identified four models for identifying people at risk in the general population; 91 diagnostic models for detecting covid-19 (60 were based on medical imaging, nine to diagnose disease severity); and 50 prognostic models for predicting mortality risk, progression to severe disease, intensive care unit admission, ventilation, intubation, or length of hospital stay. The most frequently reported predictors of diagnosis and prognosis of covid-19 are age, body temperature, lymphocyte count, and lung imaging features. Flu-like symptoms and neutrophil count are frequently predictive in diagnostic models, while comorbidities, sex, C reactive protein, and creatinine are frequent prognostic factors. C index estimates ranged from 0.73 to 0.81 in prediction models for the general population, from 0.65 to more than 0.99 in diagnostic models, and from 0.68 to 0.99 in prognostic models. All models were rated at high risk of bias, mostly because of non-representative selection of control patients, exclusion of patients who had not experienced the event of interest by the end of the study, high risk of model overfitting, and vague reporting. Most reports did not include any description of the study population or intended use of the models, and calibration of the model predictions was rarely assessed. Conclusion Prediction models for covid-19 are quickly entering the academic literature to support medical decision making at a time when they are urgently needed. This review indicates that proposed models are poorly reported, at high risk of bias, and their reported performance is probably optimistic. Hence, we do not recommend any of these reported prediction models for use in current practice. Immediate sharing of well documented individual participant data from covid-19 studies and collaboration are urgently needed to develop more rigorous prediction models, and validate promising ones. The predictors identified in included models should be considered as candidate predictors for new models. Methodological guidance should be followed because unreliable predictions could cause more harm than benefit in guiding clinical decisions. Finally, studies should adhere to the TRIPOD (transparent reporting of a multivariable prediction model for individual prognosis or diagnosis) reporting guideline. Systematic review registration Protocol https://osf.io/ehc47/ , registration https://osf.io/wy245 . Readers’ note This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This version is update 2 of the original article published on 7 April 2020 ( BMJ 2020;369:m1328), and previous updates can be found as data supplements ( https://www.bmj.com/content/369/bmj.m1328/related#datasupp ).

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Prognostic Models for Knee Osteoarthritis: A Protocol for Systematic Review, Critical Appraisal and Meta-Analysis

10.21203/rs.3.rs-70145/v1 ◽

2020 ◽

Author(s):

Jingyu Zhong ◽

Liping Si ◽

Guangcheng Zhang ◽

Jiayu Huo ◽

Yue Xing ◽

...

Keyword(s):

Systematic Review ◽

Knee Osteoarthritis ◽

Prediction Model ◽

Critical Appraisal ◽

Prediction Models ◽

Data Extraction ◽

Risk Of Bias ◽

Prognostic Models ◽

Rapid Progression ◽

Prognostic Prediction

Abstract Background: Osteoarthritis is the most common degenerative joint disease diagnosed in clinical practice. It is associated with significant socioeconomic burden and poor quality of life, a large proportion of which is due to knee osteoarthritis (KOA), mainly driven by total knee arthroplasty (TKA). As the difficulty of being detected early and deficiency of disease-modifying drug, the focus of KOA is shifting to disease prevention and the treatment to delay its rapid progression. Thus, the prognostic prediction models are called for, to stratify individuals to guide clinical decision making. The aim of our review is to identify and characterize reported multivariable prognostic models for KOA which concern about three clinical concerns: (1) the risk of developing KOA in general population; (2) the risk of receiving TKA in KOA patients; and (3) the outcome of TKA in KOA patients who plan to receive TKA.Methods: Studies will be identified by searching seven electronic databases. Title and abstract screening and full-text review will be accomplished by two independent reviewers. Data extraction instrument and critical appraisal instrument will be developed before formal assessment, and will be modified during a training phase in advance. Study reporting transparency, methodological quality, and risk of bias will be assessed according to Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement, CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) and Prediction model Risk Of Bias ASsessment Tool (PROBAST). Prognostic prediction models will be summarized qualitatively. Quantitative metrics on predictive performance of these models will be synthesized with meta-analyses if appropriate.Discussion: Our systematic review will collate evidence from prognostic prediction models that can be used through the whole process of KOA. The review may identify models which are capable of allowing personalized preventative and therapeutic interventions to be precisely targeted at those individuals who are at the highest risk. To accomplish the prediction models to cross the translational gaps between an exploratory research method and a valued addition to precision medicine workflows, research recommendations relating to model development, validation or impact assessment will be made.Systematic review registration: PROSPERO (registered, waiting for assessment, ID 203543)

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Prognostic Prediction Models for Patients with Low Back Pain: Systematic Review Protocol

10.21203/rs.3.rs-88541/v1 ◽

2020 ◽

Author(s):

Fernanda Gonçalves Silva ◽

Leonardo Oliveira Pena Costa ◽

Mark J Hancock ◽

Gabriele Alves Palomo ◽

Luciola da Cunha Menezes Costa ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Prediction Model ◽

Prediction Models ◽

External Validation ◽

Risk Of Bias ◽

Low Back ◽

Clinical Prediction ◽

Clinical Prediction Models

Abstract Background: The prognosis of acute low back pain is generally favourable in terms of pain and disability; however, outcomes vary substantially between individual patients. Clinical prediction models help in estimating the likelihood of an outcome at a certain time point. There are existing clinical prediction models focused on prognosis for patients with low back pain. To date, there is only one previous systematic review summarising the discrimination of validated clinical prediction models to identify the prognosis in patients with low back pain of less than 3 months duration. The aim of this systematic review is to identify existing developed and/or validated clinical prediction models on prognosis of patients with low back pain of less than 3 months duration, and to summarise their performance in terms of discrimination and calibration. Methods: MEDLINE, Embase and CINAHL databases will be searched, from the inception of these databases until January 2020. Eligibility criteria will be: (1) prognostic model development studies with or without external validation, or prognostic external validation studies with or without model updating; (2) with adults aged 18 or over, with ‘recent onset’ low back pain (i.e. less than 3 months duration), with or without leg pain; (3) outcomes of pain, disability, sick leave or days absent from work or return to work status, and self-reported recovery; and (4) study with a follow-up of at least 12 weeks duration. The risk of bias of the included studies will be assessed by the Prediction model Risk Of Bias ASsessment Tool, and the overall quality of evidence will be rated using the Hierarchy of Evidence for Clinical Prediction Rules. Discussion: This systematic review will identify, appraise, and summarize evidence on the performance of existing prediction models for prognosis of low back pain, and may help clinicians to choose the best option of prediction model to better inform patients about their likely prognosis. Systematic review registration: PROSPERO reference number CRD42020160988

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The Use of Prognostic Prediction Models for Mortality or Clinical Deterioration among Hospitalized and Non-hospitalized Adults with COVID-19: A Systematic Review

Acta Medica Philippina ◽

10.47895/amp.vi0.4195 ◽

2021 ◽

Author(s):

Patricia Pauline M. Remalante-Rayco ◽

Evelyn Osio-Salido

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Early Warning ◽

Prediction Models ◽

External Validation ◽

Risk Of Bias ◽

Clinical Deterioration ◽

Early Warning Score ◽

Good Prediction ◽

Prediction Of Mortality

Objective. To assess the performance of prognostic models in predicting mortality or clinical deterioration among patients with COVID-19, both hospitalized and non-hospitalized Methods. We conducted a systematic review of the literature until March 8, 2021. We included models for the prediction of mortality or clinical deterioration in COVID-19 with external validation. We used the Prediction model Risk Of Bias ASsessment Tool (PROBAST) and the GRADEpro Guideline Development Tool (GDT) to assess the evidence obtained. Results. We reviewed 33 cohort studies. Two studies had a low risk of bias, four unclear risks, and 27 with a high risk of bias due to participant selection and analysis. For the outcome of mortality, the QCOVID model had excellent prediction with high certainty of evidence but was specific for use in England. The COVID Outcome Prediction in the Emergency Department (COPE) model, the 4C Mortality Score, the Age, BUN, number of comorbidities, CRP, SpO2/FiO2 ratio, platelet count, heart rate (ABC2-SPH) risk score, the Confusion Urea Respiration Blood Pressure (CURB-65) severity score, the Rapid Emergency Medicine Score (REMS), and the Risk Stratification in the Emergency Department in Acutely Ill Older Patients (RISE UP) score had fair to good prediction of death among inpatients, while the quick Sepsis-related Organ Failure Assessment (qSOFA) score had poor to fair prediction. The certainty of evidence for these models was very low to low. For the outcome of clinical deterioration, the 4C Deterioration Score had fair prediction, the National Early Warning Score 2 (NEWS2) score poor to good, and the Modified Early Warning Score (MEWS) had poor prediction. The certainty of evidence for these three models was also very low to low. None of these models had been validated in the Philippine setting. Conclusion. The QCOVID, COPE, ABC2-SPH, 4C, CURB-65, REMS, RISE-UP models for prediction of mortality and the 4C Deterioration and NEWS2 models for prediction of clinical deterioration are potentially useful but need to be validated among patients with COVID-19 of varying severity in the Philippine setting.

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P–419 On prognosis after unexplained recurrent pregnancy losses (RPL); a systematic review and external validation of clinical prediction models

Human Reproduction ◽

10.1093/humrep/deab130.418 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

A Youssef

Keyword(s):

Systematic Review ◽

Supportive Care ◽

Prediction Model ◽

Pregnancy Outcome ◽

Prediction Models ◽

External Validation ◽

Model Development ◽

Predictive Performance ◽

Pregnancy Rates ◽

Cochrane Library

Abstract Study question Which models that predict pregnancy outcome in couples with unexplained RPL exist and what is the performance of the most used model? Summary answer We identified seven prediction models; none followed the recommended prediction model development steps. Moreover, the most used model showed poor predictive performance. What is known already RPL remains unexplained in 50–75% of couples For these couples, there is no effective treatment option and clinical management rests on supportive care. Essential part of supportive care consists of counselling on the prognosis of subsequent pregnancies. Indeed, multiple prediction models exist, however the quality and validity of these models varies. In addition, the prediction model developed by Brigham et al is the most widely used model, but has never been externally validated. Study design, size, duration We performed a systematic review to identify prediction models for pregnancy outcome after unexplained RPL. In addition we performed an external validation of the Brigham model in a retrospective cohort, consisting of 668 couples with unexplained RPL that visited our RPL clinic between 2004 and 2019. Participants/materials, setting, methods A systematic search was performed in December 2020 in Pubmed, Embase, Web of Science and Cochrane library to identify relevant studies. Eligible studies were selected and assessed according to the TRIPOD) guidelines, covering topics on model performance and validation statement. The performance of predicting live birth in the Brigham model was evaluated through calibration and discrimination, in which the observed pregnancy rates were compared to the predicted pregnancy rates. Main results and the role of chance Seven models were compared and assessed according to the TRIPOD statement. This resulted in two studies of low, three of moderate and two of above average reporting quality. These studies did not follow the recommended steps for model development and did not calculate a sample size. Furthermore, the predictive performance of neither of these models was internally- or externally validated. We performed an external validation of Brigham model. Calibration showed overestimation of the model and too extreme predictions, with a negative calibration intercept of –0.52 (CI 95% –0.68 – –0.36), with a calibration slope of 0.39 (CI 95% 0.07 – 0.71). The discriminative ability of the model was very low with a concordance statistic of 0.55 (CI 95% 0.50 – 0.59). Limitations, reasons for caution None of the studies are specifically named prediction models, therefore models may have been missed in the selection process. The external validation cohort used a retrospective design, in which only the first pregnancy after intake was registered. Follow-up time was not limited, which is important in counselling unexplained RPL couples. Wider implications of the findings: Currently, there are no suitable models that predict on pregnancy outcome after RPL. Moreover, we are in need of a model with several variables such that prognosis is individualized, and factors from both the female as the male to enable a couple specific prognosis. Trial registration number Not applicable

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Comparison of prognostic models to predict the occurrence of colorectal cancer in asymptomatic individuals: a systematic literature review and external validation in the EPIC and UK Biobank prospective cohort studies

Gut ◽

10.1136/gutjnl-2017-315730 ◽

2018 ◽

Vol 68 (4) ◽

pp. 672-683 ◽

Cited By ~ 6

Author(s):

Todd Smith ◽

David C Muller ◽

Karel G M Moons ◽

Amanda J Cross ◽

Mattias Johansson ◽

...

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Prediction Models ◽

Large Population ◽

External Validation ◽

Population Based ◽

Prognostic Models ◽

Uk Biobank ◽

Asymptomatic Individuals ◽

The Uk

ObjectiveTo systematically identify and validate published colorectal cancer risk prediction models that do not require invasive testing in two large population-based prospective cohorts.DesignModels were identified through an update of a published systematic review and validated in the European Prospective Investigation into Cancer and Nutrition (EPIC) and the UK Biobank. The performance of the models to predict the occurrence of colorectal cancer within 5 or 10 years after study enrolment was assessed by discrimination (C-statistic) and calibration (plots of observed vs predicted probability).ResultsThe systematic review and its update identified 16 models from 8 publications (8 colorectal, 5 colon and 3 rectal). The number of participants included in each model validation ranged from 41 587 to 396 515, and the number of cases ranged from 115 to 1781. Eligible and ineligible participants across the models were largely comparable. Calibration of the models, where assessable, was very good and further improved by recalibration. The C-statistics of the models were largely similar between validation cohorts with the highest values achieved being 0.70 (95% CI 0.68 to 0.72) in the UK Biobank and 0.71 (95% CI 0.67 to 0.74) in EPIC.ConclusionSeveral of these non-invasive models exhibited good calibration and discrimination within both external validation populations and are therefore potentially suitable candidates for the facilitation of risk stratification in population-based colorectal screening programmes. Future work should both evaluate this potential, through modelling and impact studies, and ascertain if further enhancement in their performance can be obtained.

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Systematic review of prediction models for pulmonary tuberculosis treatment outcomes in adults

BMJ Open ◽

10.1136/bmjopen-2020-044687 ◽

2021 ◽

Vol 11 (3) ◽

pp. e044687

Author(s):

Lauren S. Peetluk ◽

Felipe M. Ridolfi ◽

Peter F. Rebeiro ◽

Dandan Liu ◽

Valeria C Rolla ◽

...

Keyword(s):

Systematic Review ◽

Treatment Outcomes ◽

Prediction Models ◽

Assessment Tool ◽

Data Extraction ◽

External Validation ◽

Included Study ◽

Risk Of Bias ◽

Pulmonary Tb ◽

Tb Treatment

ObjectiveTo systematically review and critically evaluate prediction models developed to predict tuberculosis (TB) treatment outcomes among adults with pulmonary TB.DesignSystematic review.Data sourcesPubMed, Embase, Web of Science and Google Scholar were searched for studies published from 1 January 1995 to 9 January 2020.Study selection and data extractionStudies that developed a model to predict pulmonary TB treatment outcomes were included. Study screening, data extraction and quality assessment were conducted independently by two reviewers. Study quality was evaluated using the Prediction model Risk Of Bias Assessment Tool. Data were synthesised with narrative review and in tables and figures.Results14 739 articles were identified, 536 underwent full-text review and 33 studies presenting 37 prediction models were included. Model outcomes included death (n=16, 43%), treatment failure (n=6, 16%), default (n=6, 16%) or a composite outcome (n=9, 25%). Most models (n=30, 81%) measured discrimination (median c-statistic=0.75; IQR: 0.68–0.84), and 17 (46%) reported calibration, often the Hosmer-Lemeshow test (n=13). Nineteen (51%) models were internally validated, and six (16%) were externally validated. Eighteen (54%) studies mentioned missing data, and of those, half (n=9) used complete case analysis. The most common predictors included age, sex, extrapulmonary TB, body mass index, chest X-ray results, previous TB and HIV. Risk of bias varied across studies, but all studies had high risk of bias in their analysis.ConclusionsTB outcome prediction models are heterogeneous with disparate outcome definitions, predictors and methodology. We do not recommend applying any in clinical settings without external validation, and encourage future researchers adhere to guidelines for developing and reporting of prediction models.Trial registrationThe study was registered on the international prospective register of systematic reviews PROSPERO (CRD42020155782)

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Computational Models Used to Predict Cardiovascular Complications in Chronic Kidney Disease Patients: A Systematic Review

Medicina ◽

10.3390/medicina57060538 ◽

2021 ◽

Vol 57 (6) ◽

pp. 538

Author(s):

Alexandru Burlacu ◽

Adrian Iftene ◽

Iolanda Valentina Popa ◽

Radu Crisan-Dabija ◽

Crischentian Brinza ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Prediction Model ◽

Randomized Clinical Trials ◽

Prediction Models ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Cardiovascular Complications ◽

Risk Of Bias

Background and objectives: cardiovascular complications (CVC) are the leading cause of death in patients with chronic kidney disease (CKD). Standard cardiovascular disease risk prediction models used in the general population are not validated in patients with CKD. We aim to systematically review the up-to-date literature on reported outcomes of computational methods such as artificial intelligence (AI) or regression-based models to predict CVC in CKD patients. Materials and methods: the electronic databases of MEDLINE/PubMed, EMBASE, and ScienceDirect were systematically searched. The risk of bias and reporting quality for each study were assessed against transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) and the prediction model risk of bias assessment tool (PROBAST). Results: sixteen papers were included in the present systematic review: 15 non-randomized studies and 1 ongoing clinical trial. Twelve studies were found to perform AI or regression-based predictions of CVC in CKD, either through single or composite endpoints. Four studies have come up with computational solutions for other CV-related predictions in the CKD population. Conclusions: the identified studies represent palpable trends in areas of clinical promise with an encouraging present-day performance. However, there is a clear need for more extensive application of rigorous methodologies. Following the future prospective, randomized clinical trials, and thorough external validations, computational solutions will fill the gap in cardiovascular predictive tools for chronic kidney disease.

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Evaluating Methodological Quality of Prognostic Prediction Models on Patient Reported Outcome Measurements after Total Hip Replacement and Total Knee Replacement Surgery: a systematic review protocol

10.21203/rs.3.rs-903247/v1 ◽

2021 ◽

Author(s):

Wei-Ju Chang ◽

Justine Naylor ◽

Pragadesh Natarajan ◽

Spiro Menounos ◽

Masiath Monuja ◽

...

Keyword(s):

Systematic Review ◽

Knee Osteoarthritis ◽

Prediction Model ◽

Methodological Quality ◽

Prediction Models ◽

External Validation ◽

Model Development ◽

Patient Reported ◽

Modelling Studies

Abstract Background Prediction models for poor patient-reported surgical outcomes after total hip replacement (THR) and total knee replacement (TKR) may provide a method for improving appropriate surgical care for hip and knee osteoarthritis. There are concerns about methodological issues and the risk of bias of studies producing prediction models. A critical evaluation of the methodological quality of prediction modelling studies in THR and TKR is needed to ensure their clinical usefulness. This systematic review aims to: 1) evaluate and report the quality of risk stratification and prediction modelling studies that predict patient-reported outcomes after THR and TKR; 2) identify areas of methodological deficit and provide recommendations for future research; and 3) synthesise the evidence on prediction models associated with post-operative patient-reported outcomes after THR and TKR surgeries. Methods MEDLINE, EMBASE and CINAHL electronic databases will be searched to identify relevant studies. Title and abstract and full-text screening will be performed by two independent reviewers. We will include: 1) prediction model development studies without external validation; 2) prediction model development studies with external validation of independent data; 3) external model validation studies; and 4) studies updating a previously developed prediction model. Data extraction spreadsheets will be developed based on the CHARMS checklist and TRIPOD statement and piloted on two relevant studies. Study quality and risk of bias will be assessed using the PROBAST tool. Prediction models will be summarised qualitatively. Meta-analyses on the predictive performance of included models will be conducted if appropriate. Discussion This systematic review will evaluate the methodological quality and usefulness of prediction models for poor outcomes after THR or TKR. This information is essential to provide evidence-based healthcare for end-stage hip and knee osteoarthritis. Findings of this review will contribute to the identification of key areas for improvement in conducting prognostic research in this field and facilitate the progress in evidence-based tailored treatments for hip and knee osteoarthritis. Systematic review registration: Submitted to PROSPERO on 30 August 2021.

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Prediction Models for Future High-Need High-Cost Healthcare Use: a Systematic Review

Journal of General Internal Medicine ◽

10.1007/s11606-021-07333-z ◽

2022 ◽

Author(s):

Ursula W. de Ruijter ◽

Z. L. Rana Kaplan ◽

Wichor M. Bramer ◽

Frank Eijkenaar ◽

Daan Nieboer ◽

...

Keyword(s):

Systematic Review ◽

Care Management ◽

Prediction Models ◽

Assessment Tool ◽

Meta Analysis ◽

Model Performance ◽

Case Finding ◽

Risk Of Bias ◽

Prognostic Models ◽

Healthcare Use

Abstract Background In an effort to improve both quality of care and cost-effectiveness, various care-management programmes have been developed for high-need high-cost (HNHC) patients. Early identification of patients at risk of becoming HNHC (i.e. case finding) is crucial to a programme’s success. We aim to systematically identify prediction models predicting future HNHC healthcare use in adults, to describe their predictive performance and to assess their applicability. Methods Ovid MEDLINE® All, EMBASE, CINAHL, Web of Science and Google Scholar were systematically searched from inception through January 31, 2021. Risk of bias and methodological quality assessment was performed through the Prediction model Risk Of Bias Assessment Tool (PROBAST). Results Of 5890 studies, 60 studies met inclusion criteria. Within these studies, 313 unique models were presented using a median development cohort size of 20,248 patients (IQR 5601–174,242). Predictors were derived from a combination of data sources, most often claims data (n = 37; 62%) and patient survey data (n = 29; 48%). Most studies (n = 36; 60%) estimated patients’ risk to become part of some top percentage of the cost distribution (top-1–20%) within a mean time horizon of 16 months (range 12–60). Five studies (8%) predicted HNHC persistence over multiple years. Model validation was performed in 45 studies (76%). Model performance in terms of both calibration and discrimination was reported in 14 studies (23%). Overall risk of bias was rated as ‘high’ in 40 studies (67%), mostly due to a ‘high’ risk of bias in the subdomain ‘Analysis’ (n = 37; 62%). Discussion This is the first systematic review (PROSPERO CRD42020164734) of non-proprietary prognostic models predicting HNHC healthcare use. Meta-analysis was not possible due to heterogeneity. Most identified models estimated a patient’s risk to incur high healthcare expenditure during the subsequent year. However, case-finding strategies for HNHC care-management programmes are best informed by a model predicting HNHC persistence. Therefore, future studies should not only focus on validating and extending existing models, but also concentrate on clinical usefulness.

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