A validated electronic Frailty Index (eFI) has been developed using data from around 1 million patients through a collaboration between the University of Leeds, TPP, the University of Bradford, the University of Birmingham and Bradford Teaching Hospitals NHS Foundation Trust. It has been funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Yorkshire and Humber (NIHR CLAHRC YH).
The eFI uses existing coded primary care electronic health record data to identify frailty and grade its severity. It uses the cumulative deficit model of frailty, whereby frailty is defined on the basis of the accumulation of a range of deficits, which include 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 is now available in Primary Care through SystmOne and EMISweb electronic health records, covering approximately 90% of the UK population. The eFI can enable treatments and services to be targeted to a person based on their frailty status rather than their chronological age thus providing a paradigm shift in care for older people living in the community.
The eFI has the potential to improve care for older people with frailty by:
- directing better primary care pathways for older people by considering individual frailty rather than chronological age;
- identifying the top 2% most vulnerable patients for targeted care planning to reduce unplanned hospitalisations;
- structuring integrated care around frailty, to ensure that those who may benefit most are identified for integrated services;
- enabling targeted medication reviews for older people with frailty using evidence-based checklists (e.g. STOPP/START criteria);
- identifying the presence of frailty to guide more appropriate, shared decision making in secondary care, for example in cancer services for older people;
- identifying those with advanced frailty who may be approaching the end of their life, thus enabling advance care planning discussions.
The Healthy Ageing collaborative (part of the Yorkshire & Humber Academic Health Science Network Improvement Academy) http://www.improvement-academy.co.uk/improving-quality/healthy-ageing.html has been established to implement and evaluate the eFI. The collaborative has engaged with 55 CCGs to develop new models of frailty care using the widespread availability of the eFI to enable delivery of evidence-based interventions to potentially modify frailty trajectories and improve outcomes for older people.
The eFI has been included as a recommended tool for frailty identification within the recently published NICE Multimorbidity guideline (NG56). The eFI has won the Healthcare IT Product Innovation category at the EHI Live 2016 Awards.
Further information about this project can be found via http://www.improvement-academy.co.uk/improving-quality/healthy-ageing.html
Published research underpinning eFI: “Development and validation of an electronic frailty index using routine primary care electronic health record data”.