How Accurate is the Terminal Prognosis in the Minimum Data Set?

OBJECTIVES: To determine the sensitivity and specificity of terminal prognosis in institutional long-term care (LTC) DESIGN: The Minimum Data Set (MDS 1.0). Data in regard to deaths were collected 6 and 12 months after the assessment. SETTING: A geriatric hospital responsible for all hospital-based LTC services in one health district (population 71,000) in Helsinki, Finland. PARTICIPANTS: All LTC patients (N = 656; 81% female; mean age = 83 years) in treatment during a 1-week period. RESULTS: One-fourth (n = 164) of the 656 LTC patients had a terminal prognosis. Of these patients, 70.7% survived 6 months, and 58.5% were still alive after 1 year. Consequently, terminal prognosis was associated with a four-fold risk of 6-month mortality. The sensitivity of the terminal prognosis diagnosis was only 29%, whereas the specificity was 89%. The positive predictive accuracy was 47%, but the negative predictive accuracy was 79%. CONCLUSIONS: Terminal prognosis was clearly overdiagnosed. More information is needed about short-term mortality in terminal prognosis patients and whether this diagnosis affects survival rates.