RESPECT Calculator

The algorithm used in this calculator is called RESPECT. RESPECT is short for Risk Evaluation for Support: Predictions for Elder life in the Community Tool.

RESPECT was developed on data from 491,277 older people in Ontario, Canada, who used home care between 2007 and 2013. The dataset contains detailed health information from the standardized Resident Assessment Instrument for Home Care (RAI-HC), which case managers and nurses use to assess the needs of home care users. The calculator includes a wide range of questions that reflect different trajectories in physical health and cognition, including age, sex, cognitive impairment (memory decline), diseases (e.g. diabetes, cardiovascular disease, dementia, cancer), sociodemographic factors (marital status, level of education), health status (e.g. difficulties with activities of daily living), symptoms of reduced physiologic reserve (e.g. weight loss), use life-sustaining therapies (e.g., dialysis), and health care use (e.g., number of hospitalizations and emergency department visits).

The algorithm is calibrated to 1.3 million assessments and 112,823 deaths. RESPECT accurately predicts a wide range in life expectancy; we ranked and classified our cohort based on their six-month risk of death, which spanned from 1.5% to 98%. This translates to an average survival of 4 weeks (interquartile range [IQR] of 11 to 84 days) for the frailest people in our cohort to 8.1 years among people with the few physical limitations and chronic health conditions (IQR of 5.9 years to 9.4 years).

RESPECT is incorporated into the Project Big Life scoring engine. The scoring engine generates calculations on any combination of responses to the algorithm questions. The main output of the engine is the actual health experience of Ontarians who completed the 1.3 million assessments. These health experiences can be translated into a wide range of patient-oriented measures. For more information on how we developed the RESPECT–End of Life algorithm, click here.

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References‍

Hsu AT, Manuel DG, Taljaard M, Chalifoux M, Bennett C, Costa AP, . . . Tanuseputro P. 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). BMJ Open 2016;6:e013666. doi:10.1136/bmjopen-2016- 013666‍

Amy T. Hsu, Douglas G. Manuel, Sarah Spruin, Carol Bennett, . . . Peter Tanuseputro: Predicting death in home care users: derivation and validation of the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT). CMAJ Jul 2021, 193 (26) E997-E1005; DOI: 10.1503/cmaj.200022

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