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Development and Validation of an Electronic Frailty Index Using Routine Electronic Health Records: An Observational
Yao-Dan Liang1,2, Yi-Bo Xie3, Ming-Hui Du1
1Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Frontiers in Medicine
|October 15, 2021
Summary
This study developed an electronic frailty index (eFI) using electronic health records (EHR) for older inpatients. The validated eFI effectively predicts longer hospital stays, in-hospital death, and increased healthcare costs associated with frailty.
Area of Science:
- Geriatrics
- Health Informatics
- Public Health
Background:
- Frailty assessment in older adults is crucial for predicting health outcomes.
- Electronic Health Records (EHR) offer a potential data source for developing frailty indices.
- Current frailty assessment methods may not be routinely integrated into clinical workflows.
Purpose of the Study:
- To develop and validate an electronic frailty index (eFI) using routine EHR data.
- To assess the correlation between the eFI and hospital events such as prolonged stay and mortality.
- To analyze the association between frailty levels and hospitalization costs.
Main Methods:
- An eFI was constructed from routine EHR data of older adult inpatients.
- The eFI's effectiveness was validated against the comprehensive geriatric assessment-frailty index (CGA-FI) in a prospective cohort.
- Regression analyses were performed to examine associations between eFI and hospital outcomes and costs.
Main Results:
- A strong correlation (Pearson's r = 0.716) was found between the eFI and CGA-FI.
- An eFI threshold (≥0.15) demonstrated good sensitivity (64.8%) and specificity (88.7%) for identifying frailty.
- Higher eFI scores were independently associated with longer hospital stays (OR = 2.889) and in-hospital death (OR = 19.97).
- Increased eFI values correlated positively with total hospitalization costs, including examination, treatment, nursing, pharmacy, and material costs.
Conclusions:
- An effective eFI was successfully developed and validated using routine EHR in a Chinese hospital setting.
- Frailty, as measured by eFI, is an independent risk factor for adverse hospital events.
- Increasing frailty severity is directly associated with escalating hospitalization expenses.
