Validation of an electronic frailty index with electronic health records: eFRAGICAP index

Abstract

Objective To create an electronic frailty index (eFRAGICAP) using electronic health records (EHR) in Catalunya (Spain) and assess its predictive validity with a two-year follow-up of the outcomes: homecare need, institutionalization and mortality in the elderly. Additionally, to assess its concurrent validity compared to other standardized measures: the Clinical Frailty Scale (CFS) and the Risk Instrument for Screening in the Community (RISC). Methods The eFRAGICAP was based on the electronic frailty index (eFI) developed in United Kingdom, and includes 36 deficits identified through clinical diagnoses, prescriptions, physical examinations, and questionnaires registered in the EHR of primary health care centres (PHC). All subjects > 65 assigned to a PHC in Barcelona on 1st January, 2016 were included. Subjects were classified according to their eFRAGICAP index as: fit, mild, moderate or severe frailty. Predictive validity was assessed comparing results with the following outcomes: institutionalization, homecare need, and mortality at 24 months. Concurrent validation of the eFRAGICAP was performed with a sample of subjects (n = 333) drawn from the global cohort and the CFS and RISC. Discrimination and calibration measures for the outcomes of institutionalization, homecare need, and mortality and frailty scales were calculated. Results 253,684 subjects had their eFRAGICAP index calculated. Mean age was 76.3 years (59.5% women). Of these, 41.1% were classified as fit, and 32.2% as presenting mild, 18.7% moderate, and 7.9% severe frailty. The mean age of the subjects included in the validation subsample (n = 333) was 79.9 years (57.7% women). Of these, 12.6% were classified as fit, and 31.5% presented mild, 39.6% moderate, and 16.2% severe frailty. Regarding the outcome analyses, the eFRAGICAP was good in the detection of subjects who were institutionalized, required homecare assistance, or died at 24 months (c-statistic of 0.841, 0.853, and 0.803, respectively). eFRAGICAP was also good in the detection of frail subjects compared to the CFS (AUC 0.821) and the RISC (AUC 0.848). Conclusion The eFRAGICAP has a good discriminative capacity to identify frail subjects compared to other frailty scales and predictive outcomes.

Dynamics of multimorbidity and frailty, and their contribution to mortality, nursing home and home care need: A primary care cohort of 1 456 052 ageing people

“…Prevalence of frailty deficits was similar to those reported by previous papers using SIDIAP databases. 4 , 21 …”

“…We also used standardised validated tools for measuring both multimorbidity 10 and frailty. 18 , 21 Similarly to other frailty indices based on EHR, eFRAGICAP may show a greater multimorbidity burden because diagnoses are more routinely collected than other frailty-related information. For this reason, eFRAGICAP was also considered according to the nature of the deficits considered, i.e., disease- or SSLD-related.…”

“…CFS, RISC). 21 The frailty index could be improved by including inflammatory biomarkers that are precursors driving frailty and late-life decline, 32 and other geriatric health indicators (Health Assessment Tool and Walking Speed 33 ). However, any additional information can be easily included in the frailty index if the data are available.…”

“…Frailty was measured using eFRAGICAP, a validated adaptation of the eFI that uses EHR from Catalan primary care centres. 21 The eFRAGICAP includes 36 possible deficits based on medical, pharmacy, and laboratory data from the EHR. Twenty deficits refer to diagnoses and 16 to signs/symptoms, laboratory results, and disabilities (SSLD) (see Table S1).…”

“…The eFI has been validated in other EHR systems, including in Catalonia, known as eFRAGICAP. 21 For their part, frailty indexes have proven useful to measure the risk of mortality and other adverse health outcomes in older adults. 18,22 Multimorbidity and frailty are associated.…”