{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T05:47:14Z","timestamp":1775022434847,"version":"3.50.1"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U54AG063546"],"award-info":[{"award-number":["U54AG063546"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Imbedded Pragmatic Alzheimer's Disease"},{"name":"AD-Related Dementias Clinical Trials Collaboratory"},{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["UL1TR004929"],"award-info":[{"award-number":["UL1TR004929"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23AG070234"],"award-info":[{"award-number":["K23AG070234"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23AG073529"],"award-info":[{"award-number":["K23AG073529"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To examine the discrimination, calibration, and algorithmic fairness of the Epic End of Life Care Index (EOL-CI).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We assessed the EOL-CI\u2019s performance by estimating area under the receiver operating characteristic curve (AUC), sensitivity, and positive and negative predictive values in community-dwelling adults \u226565 years of age in a single health system in the Southeastern United States. Algorithmic fairness was examined by comparing the model\u2019s performance across sex, race, and ethnicity subgroups. Using a machine learning approach, we also explored local re-calibration of the EOL-CI considering additional information on past hospitalizations and frailty.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 215\u00a0731 patients (median age\u2009=\u200974 years, 57% female, 12% of Black race), 10% were classified as medium risk (15-44) and 3% as high risk (\u226545) by the EOL-CI. The observed 1-year mortality rate was 3%. The EOL-CI had an AUC 0.82 for 1-year mortality, with a positive predictive value of 22%. Predictive performance was generally similar across sex and race subgroups, though the EOL-CI displayed better performance with increasing age and in older adults with 2 or more outpatient encounters in the past 24 months. Local re-calibration of the EOL-CI was required to provide absolute estimates of mortality risk, and calibration was further improved when the EOL-CI was augmented with data on inpatient hospitalizations and frailty.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>The EOL-CI demonstrates reasonable discrimination, albeit with better performance in older adults and in those with greater health system contact.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Local refinement and calibration of the EOL-CI score is required to provide direct estimates of prognosis, with the goal of making the EOL-CI a more a valuable tool at the point of care for identifying patients who would benefit from targeted palliative care interventions and proactive care planning.<\/jats:p>\n               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M","family":"Lenoir","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC 27157,","place":["United States"]},{"name":"Center for Health System Sciences (CHASSIS), Wake Forest University School of Medicine, Winston-Salem, NC 27157,","place":["United States"]},{"name":"Center for Health System Sciences (CHASSIS), Wake Forest University School of Medicine, Atrium Heath , Charlotte, NC, Charlotte, NC 28203,","place":["United States"]}]},{"given":"Jessica A","family":"Palakshappa","sequence":"additional","affiliation":[{"name":"Section on Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Department of Internal Medicine, Wake Forest University School of Medicine , Winston-Salem, NC,","place":["United States"]}]},{"given":"Brian J","family":"Wells","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, Wake Forest University School of 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