The MDS‐CHESS Scale: A New Measure to Predict Mortality in Institutionalized Older People

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Abstract
OBJECTIVES: To develop a scale predicting mortality and other adverse outcomes associated with frailty.DESIGN: Observational study based on Minimum Data Set (MDS) 2.0 and mortality data.SETTING: Ontario chronic hospitals.PARTICIPANTS: All chronic hospital patients (N = 28,495) assessed with the MDS 2.0 after mandatory implementation in July 1996 followed until May 1999.MEASUREMENTS: MDS 2.0 assessments done as part of normal practice mainly by registered nurses or multidisciplinary teams in a chronic hospital. Mortality data are available from the accompanying discharge tracking form.RESULTS: The MDS‐Changes in Health, End‐stage disease and Symptoms and Signs (CHESS) score is a composite measure addressing changes in health, end‐stage disease, and symptoms and signs of medical problems. It is a strong predictor of mortality (P < .0001) independent of the effects of age, sex, activities of daily living impairment, cognition, and do‐not‐resuscitate orders. It is also strongly associated with physician activity, complex medical procedures, and pain (P < .001 for each dependent variable).CONCLUSIONS: The CHESS score provides a useful new MDS‐based test to predict mortality and to measure instability in health as a clinical outcome.

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