Abstract
IntroductionIndividuals who have been identified as frail have an increased state of vulnerability, often leading to adverse health events, increased health spending, and potentially detrimental outcomes.ObjectiveThe objective of this work is to develop and validate a case definition for frailty that can be used in a primary care electronic medical record database.MethodsThis is a cross-sectional validation study using data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) in Southern Alberta. 52 CPCSSN sentinels assessed a random sample of their own patients using the Rockwood Clinical Frailty scale, resulting in a total of 875 patients to be used as reference standard. Patients must be over the age of 65 and have had a clinic visit within the last 24 months. The case definition for frailty was developed using machine learning methods using CPCSSN records for the 875 patients.ResultsOf the 875 patients, 155 (17.7%) were frail and 720 (84.2%) were not frail. Validation metrics of the case definition were: sensitivity and specificity of 0.28, 95% CI (0.21 to 0.36) and 0.94, 95% CI (0.93 to 0.96), respectively; PPV and NPV of 0.53, 95% CI (0.42 to 0.64) and 0.86, 95% CI (0.83 to 0.88), respectively.ConclusionsThe low sensitivity and specificity results could be because frailty as a construct remains under-developed and relatively poorly understood due to its complex nature. These results contribute to the literature by demonstrating that case definitions for frailty require expert consensus and potentially more sophisticated algorithms to be successful.
Highlights
Individuals who have been identified as frail have an increased state of vulnerability, often leading to adverse health events, increased health spending, and potentially detrimental outcomes
The low sensitivity and specificity results could be because frailty as a construct remains underdeveloped and relatively poorly understood due to its complex nature. These results contribute to the literature by demonstrating that case definitions for frailty require expert consensus and potentially more sophisticated algorithms to be successful
∗Corresponding Author: Email Address: tyler.williamson@ucalgary.ca (T Williamson) decision-makers to identify frailty is important as it is predictive of adverse health events and increased health spending [4,5,6,7,8]
Summary
Individuals who have been identified as frail have an increased state of vulnerability, often leading to adverse health events, increased health spending, and potentially detrimental outcomes. 5% of the population, many of whom are frail, are considered high users of the healthcare system and account for the majority (60%) of healthcare utilization and costs [9,10,11]. In part, these hospital costs are due to those who are severely frail (completely dependent for personal care) to terminally ill [12]. The last years of life for those living in Ontario cost $4.7B annually, comprising 10% of all government-funded health care [13]
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