A cross-sectional study examining convergent validity of a frailty index based on electronic medical records in a Canadian primary care program

Abstract

Background An electronic frailty index (eFI) has been developed and validated in the UK; it uses data from primary care electronic medical records (EMR) for effective frailty case-finding in primary care. This project examined the convergent validity of the eFI from Canadian primary care EMR data with a validated frailty index based on comprehensive geriatric assessment (FI-CGA), in order to understand its potential use in the Canadian context. Methods A cross-sectional validation study, using data from an integrated primary care research program for seniors living with frailty in Edmonton, AB. Eighty-five patients 65 years of age and older from six primary care physicians’ practices were recruited. Patients were excluded if they were under 65 years of age, did not provide consent to participate in the program, or were living in a long term care facility at the time of enrolment. We used scatter plots to assess linearity and Pearson correlation coefficients to examine correlations. Results Results indicate a strong statistically significant correlation between the eFI and FI-CGA (r = 0.72, 95% CI 0.60–0.81, p < 0.001). A simple linear regression showed good ability of the eFI scores to predict FI-CGA scores (F (1,83) = 89.06, p < .0001, R2 = 0.51). Both indices were also correlated with age, number of chronic conditions and number of medications. Conclusions The study findings support the convergent validity of the eFI, which further justifies implementation of a case-finding tool that uses routinely collected primary care data in the Canadian context.

Development and validation of an electronic frailty index using routine electronic health records: an observational study of 49,226 elderly inpatients from a general hospital in China

“…In this study, we constructed an eFI to assess frailty in elderly inpatients by using routine EHR data in a general hospital. Our results showed a strong correlation between the eFI and CGA-FI, which was consistent with the ndings of Brundle C et al in the UK [12] and Abbasi M et al in Canada [21]. Other frailty assessment tools based on routine EHR data, such as the hospital frailty risk score [11] and care assessment need score [22], also showed good agreement with traditional frailty measurements.…”

“…Pajewski N et al and Abbasi M et al improved the composition of the eFI by adding some laboratory tests and functional abilities [10,21]. We also agree with this improvement.…”

“…Therefore, if we continued to use 0.25 as the cut-off value for the eFI, it will obviously underestimate the prevalence of the frail population. However, there was only one similar study that simultaneously compared the eFI and CGA-FI [21]. This study also showed that the eFI was relatively lower than the CGA-FI (eFI: mean = 0.30, max = 0.58, min = 0.08 vs. CGA-FI: mean = 0.35, max = 0.69, min = 0.10) for 85 participants in a Canadian primary care programme [21].…”

“…However, there was only one similar study that simultaneously compared the eFI and CGA-FI [21]. This study also showed that the eFI was relatively lower than the CGA-FI (eFI: mean = 0.30, max = 0.58, min = 0.08 vs. CGA-FI: mean = 0.35, max = 0.69, min = 0.10) for 85 participants in a Canadian primary care programme [21]. There were several possible reasons why our eFI values were obviously lower than those of the CGA-FI and another reported eFI [10,12].…”

“…However, if the admission diagnosis is improved by coding in the future, we would be able to obtain the eFI within 24 hours after admission, which would help clinicians make clinical decisions for inpatients in a timely manner and predict the outcome of elderly inpatients in the hospital. In previous studies, the eFI was mainly developed in primary care settings [9,10,21], and only one study focused on hospital acute care settings [11]. Compared with relatively complete hospitalization records, the cleaning of primary medical data is more complicated.…”