Development and validation of an electronic frailty index using routine primary care electronic health record data - PubMed (original) (raw)

Comparative Study

Development and validation of an electronic frailty index using routine primary care electronic health record data

Andrew Clegg et al. Age Ageing. 2016 May.

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Abstract

Background: frailty is an especially problematic expression of population ageing. International guidelines recommend routine identification of frailty to provide evidence-based treatment, but currently available tools require additional resource.

Objectives: to develop and validate an electronic frailty index (eFI) using routinely available primary care electronic health record data.

Study design and setting: retrospective cohort study. Development and internal validation cohorts were established using a randomly split sample of the ResearchOne primary care database. External validation cohort established using THIN database.

Participants: patients aged 65-95, registered with a ResearchOne or THIN practice on 14 October 2008.

Predictors: we constructed the eFI using the cumulative deficit frailty model as our theoretical framework. The eFI score is calculated by the presence or absence of individual deficits as a proportion of the total possible. Categories of fit, mild, moderate and severe frailty were defined using population quartiles.

Outcomes: outcomes were 1-, 3- and 5-year mortality, hospitalisation and nursing home admission.

Statistical analysis: hazard ratios (HRs) were estimated using bivariate and multivariate Cox regression analyses. Discrimination was assessed using receiver operating characteristic (ROC) curves. Calibration was assessed using pseudo-R(2) estimates.

Results: we include data from a total of 931,541 patients. The eFI incorporates 36 deficits constructed using 2,171 CTV3 codes. One-year adjusted HR for mortality was 1.92 (95% CI 1.81-2.04) for mild frailty, 3.10 (95% CI 2.91-3.31) for moderate frailty and 4.52 (95% CI 4.16-4.91) for severe frailty. Corresponding estimates for hospitalisation were 1.93 (95% CI 1.86-2.01), 3.04 (95% CI 2.90-3.19) and 4.73 (95% CI 4.43-5.06) and for nursing home admission were 1.89 (95% CI 1.63-2.15), 3.19 (95% CI 2.73-3.73) and 4.76 (95% CI 3.92-5.77), with good to moderate discrimination but low calibration estimates.

Conclusions: the eFI uses routine data to identify older people with mild, moderate and severe frailty, with robust predictive validity for outcomes of mortality, hospitalisation and nursing home admission. Routine implementation of the eFI could enable delivery of evidence-based interventions to improve outcomes for this vulnerable group.

Keywords: cumulative deficit; electronic frailty index; electronic health record; frailty; older people; primary care.

© The Author 2016. Published by Oxford University Press on behalf of the British Geriatrics Society.

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Figures

Figure 1.

Figure 1.

Five-year Kaplan–Meier survival curve for the outcome of mortality for categories of fit, mild frailty, moderate frailty and severe frailty (internal validation cohort).

Figure 2.

Figure 2.

Relationship between age, electronic frailty index score and mortality (internal validation cohort).

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References

    1. Clegg A, Young J, Iliffe S, Olde-Rikkert M, Rockwood K. Frailty in elderly people. Lancet 2013; 381: 752–62. - PMC - PubMed
    1. Fried LP, Tangen CM, Walston J et al. . Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–56. - PubMed
    1. Rockwood K, Mitnitski A, Song X, Steen B, Skoog I. Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. J Am Geriatr Soc 2006; 54: 975–9. - PubMed
    1. Rodriguez-Manas L, Fried LP. Frailty in the clinical scenario. Lancet 2014; 385: e7–9. - PubMed
    1. Turner G, Clegg A. Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing 2014; 43: 744–7. - PubMed

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