As part of NIHR CLAHRC YH, Andy Clegg and John Young, from the Academic Unit of Elderly Care & Rehabilitation, University of Leeds, have untertaken collaboration with Chris Bates and John Parry at TPP/ResearchOne to develop and validate an electronic frailty index (eFI) that uses existing electronic health record data to identify and severity grade frailty. The eFI has been developed using the cumulative deficit model of frailty, whereby frailty is defined on the basis of the accumulation of a range of deficits, which are clinical signs (e.g. tremor), symptoms (e.g. breathlessness), diseases (e.g. hypertension) and disabilities. The eFI consists of 36 deficits which have been constructed using around 2,000 primary care clinical codes (Read codes). The eFI calculates a frailty score by dividing the number of deficits present by the total possible. For example, if a patient has 9 out of 36 deficits, the eFI score is 0.25. The score is a robust predictor of those who are at greater risk of adverse outcomes (e.g. care home admission and mortality). The eFI has been developed and validated using data from around 500,000 patients in ResearchOne. The eFI is now available to GPs in SystmOne and will be available in other health record systems in 2016.
The eFI will help improve care for older people with frailty by:
1) Directing better primary care pathways for older people by considering individual frailty rather than chronological age
2) Identifying the top 2% most vulnerable patients for targeted care planning to reduce unplanned hospitalisations
3) Structuring integrated care around frailty, to ensure that those who may benefit most are identified for integrated services
4) Enabling targeted medication reviews for older people with frailty using evidence-based checklists (e.g. STOPP/START criteria)
5) Identifying the presence of frailty to guide more appropriate, shared decision making in secondary care, for example in cancer services for older people
6) Identifying those with advanced frailty who may be entering the terminal phase of life for advance care planning discussions
The researchers have established a Healthy Ageing collaborative as part of the YH AHSN Improvement Academy to implement and evaluate the eFI for use as a practice report to facilitate improved services for older people with frailty. The eFI is being piloted with a number of collaborator practices across Yorkshire & Humber, and nationally.