Design and rationale of the Western Sydney Clinical Frailty Registry: A prospective observational long-term clinical cohort study

Abstract

BackgroundFrail older adults are frequently admitted to hospital with complex care needs, however little is known about their clinical profile, inpatient management or outcomes. Aims(i) To establish a baseline clinical profile of patients with frailty; (ii) To obtain a representative cross-sectional view of patients with frailty and their acute inpatient clinical management; (iii) To determine the rate and clinical outcomes of frailty among hospitalised patients. MethodsThe study will be conducted in a Western Sydney tertiary teaching hospital (Blacktown and Mount Druitt Hospital), serving a large socio-economically diverse, multi-cultural community. A long-term, prospective observational clinical cohort of patients who are admitted under Rehabilitation and Aged Care Services over the next 5-year period (2020–25) will be conducted. Frailty will be assessed using the Clinical Frailty Scale, and the FI-ED frailty instrument, performance will be assessed using the Australian-modified Karnofsky Performance Status (AKPS). Participants will be followed-up at 3, 6, and 12 months by telephone, following their index hospitalisation. Outcomes of interest include all-cause rehospitalisation (including emergency department presentation), mortality and admission to residential aged care service over the period of 12 months. Data Linkage endpoint assessment will be undertaken at 1, 2, and 5 years. DiscussionFrailty is an emergent area of clinical and research interest. It is an important prognostic indicator of mortality, rehospitalisation and institutionalisation. ConclusionThis study will provide longitudinal data to demonstrate short, mid, or long-term outcomes of hospitalised frail older adults. Data will be used to inform future studies and quality improvement activities. ImpactIt is envisioned that the registry will act as a spine project for future multi-disciplinary research opportunities including interventional studies, data linkage studies and quality improvement projects, thus enabling robust medium – long term examination of outcomes of interest, such as mortality, rehospitalisation and admission to residential aged care within this area of growing concern. There are plans to engage more disciplines in the registry's research capacity-building endeavours and we have identified the need for greater consumer engagement and public involvement. The sustainability of the registry needs to be considered within the context of ongoing research funding and making better use of these data for continuous quality improvement. Registry registrationThe registry was registered with the Australian Register of Clinical Registries (Australian Commission on Safety and Quality in Healthcare) on 3rd August 2020.(Australian Commission on Safety and Quality in Healthcare, 2020) Reference ACSQHC-ARCR-095. Available via https://www.safetyandquality.gov.au/australian-register-clinical-registries