1013 DIAGNOSTIC TEST ACCURACY OF FRAILTY SCREENING TOOLS USING DATA IN ELECTRONIC PRIMARY CARE RECORDS

Abstract

Abstract Introduction Targeted interventions aimed at people living with frailty key to NHS Strategy and is incentivised in the NHS England GP contract. eFrailty, and similar risk prediction tools aim to detect frail people automatically from their electronic primary care health-records and can predict mortality and hospital admission. We carried out a systematic review of currently available risk prediction tools to assess frailty using primary care data. Method We searched Medline, Pubmed, CENTRAL, CINHAL and Embase to identify studies comparing a frailty assessment utilising primary care records with face-to-face assessment with a healthcare professional. Studies were quality assessed using QUADAS-2. Sensitivity and specificity values were extracted directly or calculated and pooled using StatsDirect. Results The initial search generated 2,245 titles with 10 studies remaining for review after screening. This described 3 different index tests (electronic frailty index (eFI), claims-based frailty index (cFI), and polypharmacy. Frailty Phenotype was the reference standard in each study. 1 study of 60 patients, average age 80.2 examined eFI, with a pooled sensitivity of 0.84 (95% CI 0.55,0.98), and specificity of 0.78 (0.64,0.89). 2 studies of 7,679 patients, average age 75.5, examined cFI, with a pooled sensitivity of 0.84 (95% CI 0.55,0.98), and specificity of 0.78 (0.64,0.89). 7 studies of 34,328 patients, average age 77.4, examined a polypharmacy as a screening tool (defined as ≥5 medications) with a pooled sensitivity of 0.84 (95% CI 0.55,0.98), and specificity of 0.78 (0.64,0.89). Conclusion eFI performed best however, for an average UK GP practice with a list size of 10,000, 18% of patients aged over 65, of which 20% were frail, eFI would flag 597 as frail, of which 272 would be actually frail, and an additional 51 frail patients would be missed. In conclusion, existing frailty risk prediction tools would have strictly limited value in UK primary care currently.