Development and validation of a hospital frailty risk measure using Canadian clinical administrative data

Abstract

Background: Accessible measures specific to the Canadian context are needed to support health system planning for older adults living with frailty. We sought to develop and validate the Canadian Institute for Health Information (CIHI) Hospital Frailty Risk Measure (HFRM). Methods: Using CIHI administrative data, we conducted a retrospective cohort study involving patients aged 65 years and older who were discharged from Canadian hospitals from Apr. 1, 2018, to Mar. 31, 2019. We used a 2-phase approach to develop and validate the CIHI HFRM. The first phase, construction of the measure, was based on the deficit accumulation approach (identification of age-related conditions using a 2-year look-back). The second phase involved refinement into 3 formats (continuous risk score, 8 risk groups and binary risk measure), with assessment of their predictive validity for several frailty-related adverse outcomes using data to 2019/20. We assessed convergent validity with the United Kingdom Hospital Frailty Risk Score. Results: The cohort consisted of 788 701 patients. The CIHI HFRM included 36 deficit categories and 595 diagnosis codes that cover morbidity, function, sensory loss, cognition and mood. The median continuous risk score was 0.111 (interquartile range 0.056–0.194, equivalent to 2–7 deficits); 35.1% ( n = 277 000) of the cohort were found at risk of frailty (≥ 6 deficits). The CIHI HFRM showed satisfactory predictive validity and reasonable goodness-of-fit. For the continuous risk score format (unit = 0.1), the hazard ratio (HR) for 1-year risk of death was 1.39 (95% confidence interval [CI] 1.38–1.41), with a C-statistic of 0.717 (95% CI 0.715–0.720); the odds ratio for high users of hospital beds was 1.85 (95% CI 1.82–1.88), with a C-statistic of 0.709 (95% CI 0.704–0.714), and the HR of 90-day admission to long-term care was 1.91 (95% CI 1.88–1.93), with a C-statistic of 0.810 (95% CI 0.808–0.813). Compared with the continuous risk score, using a format of 8 risk groups had similar discriminatory ability and the binary risk measure had slightly weaker performance. Interpretation: The CIHI HFRM is a valid tool showing good discriminatory power for several adverse outcomes. The tool can be used by decision-makers and researchers by providing information on hospital-level prevalence of frailty to support system-level capacity planning for Canada’s aging population.

Identifying Predictors of Nursing Home Admission by Using Electronic Health Records and Administrative Data: Scoping Review

“…These data can be readily integrated into clinical computer systems, automatically populated, and made available without requiring additional resource input [ 44 ]. Further, although we found some studies that used large sample sizes comprised of more than 200,000 participants [ 18 , 20 , 28 , 31 , 43 , 44 , 47 ], this did not necessarily mean that the predictors or outcome variables were distinctive. In addition, although many studies used administrative claims data, the use of billing information or the construction of cost predictors was rarely observed.…”

“…On the other hand, frailty was used in 8 studies. Among these 8 studies, 5 reported the development and validation of prediction models using different frailty index scores [ 27 , 28 , 33 , 35 , 44 ]. Another structured score that was used to predict NHA was the Identification of Seniors at Risk score, which is a standardized, comprehensive geriatric assessment tool administered at admission to a hospital [ 38 ].…”

Correlation of the clinical frailty scale and the frailty algorithm proposed by Dalhousie University in older adults

“…Por ello, la Universidad de Dalhousie durante la pandemia por COVID-19 propuso elaborar un algoritmo enfocado en las comorbilidades, alteraciones de salud autorreportadas, dependencia para actividades básicas e instrumentales de la vida diaria que podrían ayudar a determinar el nivel de fragilidad en adultos mayores de manera más certera. El presente estudio tuvo como objetivo determinar la relación entre el algoritmo propuesto por la Universidad de Dalhousie y la Escala Clínica de Fragilidad (CFS) en adultos mayores en diferentes niveles asistenciales durante la pandemia por COVID-19 (1,2) .…”