Yes / 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-R2 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.
| Identifer | oai:union.ndltd.org:BRADFORD/oai:bradscholars.brad.ac.uk:10454/7929 |
| Date | 20 January 2016 |
| Creators | Clegg, A., Bates, C., Young, J., Ryan, R., Nichols, L., Teale, E.A., Mohammed, Mohammed A., Parry, J., Marshall, T. |
| Source Sets | Bradford Scholars |
| Language | English |
| Detected Language | English |
| Type | Article, Published version |
| Rights | © 2016 The Authors. Published open access by Oxford Journals. Reproduced in accordance with the publisher's self-archiving policy. |
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