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Development of a frailty measure to inform quality of care Joseph - - PowerPoint PPT Presentation

Sep 09, 2022 366 likes •599 views

Defining Frailty in Acute Care: Development of a frailty measure to inform quality of care Joseph Emmanuel Amuah Canadian Institute for Health Information cihi.ca @cihi_icis September 27, 2019 Jamuah@ Why measure frailty in acute care now?

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Canadian Institute for Health Information cihi.ca @cihi_icis

Defining Frailty in Acute Care: Development of a frailty measure to inform quality of care

September 27, 2019 Jamuah@

Joseph Emmanuel Amuah

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Why measure frailty in acute care now?

An increasing number Canadians will become frail Frail individuals have increased care needs that are dynamic Frailty measures are available and in use for home care, long term care, and assisted living but not in systematic use in acute care Comprehensive geriatric assessments are preferred but expensive to implement

There is no commonly used pan-Canadian measure in inpatient acute care

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Methodology

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Development of a frailty risk score

  • Accumulation of deficits is used to determine the frailty risk score.

‒ Cumulative deficit models are closely related to the biological age of the individual being examined for frailty ‒ Common deficits include signs, symptoms, abnormal lab values, disease states and disabilities

  • List of deficits were established based on extensive consultation with experts in the

field, the Searle et al. criteria, and data analysis.

  • Linear regression analysis was performed to assign weights to each deficit. Weights were

then used to calculate frailty risk scores.

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Inclusion and exclusion criteria

  • Includes all in-patient hospital stays during a one year period (FY2016-2017)
  • Includes patients aged 65 and older
  • Excludes maternity and abortion patients
  • Excludes patients who received care in Quebec a Quebec health card number
  • Databases for inclusion or validation:

‒ Discharge Abstract Database (DAD) ‒ Continuing Care and Home Care Reporting Systems (CCRS and HCRS) ‒ National Rehabilitation System (NRS)

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List of deficits (36 condition categories)

Morbidity

  • Anemia
  • Cardiac
  • Cancer
  • Cerebrovascular
  • Diabetes
  • Gastrointestinal
  • Hypo- and

hypertension

  • Incontinence
  • Renal
  • Respiratory
  • Thrombosis and

embolisms

Function

  • Instrumental activities
  • f daily living (IADLs)
  • Arthritis and

inflammation

  • Movement and

immobility

  • Fatigue
  • Functional

dependence

  • Fractures and
  • steoporosis
  • Musculoskeletal
  • Machine dependence
  • Edema

Sensory Loss

  • Sensory impairment

Other

  • Endocrine
  • Epilepsy
  • History of medications
  • Infections
  • Nutrition and wasting
  • Pain
  • Organ transplants and
  • stomies
  • Other frailty conditions

and diseases

  • Other injuries
  • Ulcers and soft tissue

disorders

Cognition & Mood

  • Delirium
  • Delusions and

hallucinations

  • Dementia and

Alzheimer's

  • Other cognitive

disorders

  • Mood disorders
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Preliminary Results

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Distribution of frailty risk score among patients aged 65+

0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 0.00 0.03 0.06 0.08 0.11 0.14 0.17 0.19 0.22 0.25 0.28 0.31 0.33 0.36 0.39 0.42 0.44 0.47 0.50 0.53 0.56 0.58

% of patients Frailty Risk Score (Unweighted)

Risk of frailty increases

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Distribution of weighted frailty risk score among patients aged 65+

Risk of frailty increases

2 4 6 8 10 12 14 16 18 20 0.18 0.19 0.2 0.21 0.22 0.23 0.24 0.25 0.26 0.27 0.28 0.29 0.3 0.31 0.32 0.33 0.34 0.35 0.36 0.37 0.38 0.39 0.4 0.41 0.42 0.43 % of patients Weighted Frailty Risk Score

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Frailty risk score – Condition category weights

Top 10 highest weighted condition categories

Condition category Weight Dementia and Alzheimer’s 0.0386 Cerebrovascular 0.038 Instrumental activities of daily living (IADLs) 0.0333 Functional dependence 0.0219 Movement and immobility 0.0195 Delirium 0.0187 Diabetes 0.0175 Fatigue 0.017 Infections 0.0169 Fractures and osteoporosis 0.0147

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Validation process

  • Comparison with other published frailty indices
  • Construct and predictive validity
  • Sensitivity analysis (planned)
  • Frail status over time (planned)
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Comparison with other frailty measures

  • Gilbert et al (2018), Campitelli (2016), and Morris, Howard, & Steel (2016) were found to be most highly correlated

Frailty Measure Description of Frailty measure Correlation with CIHI’s Unweighted Frailty Risk Score Correlation with CIHI’s Weighted Frailty Risk Score

Frailty risk score (Gilbert et al., 2018) Risk score created using cluster analysis on ICD-10 codes in electronic hospital records 0.77 0.73 Frailty Index using HCRS (Campitelli, 2016) Index created using Resident Assessment Instrument (RAI) data in HCRS clients with full

  • assessments. 72-items were included.

0.24 0.36 Frailty Scale using HCRS (Morris, Howard, & Steel, 2016) Frailty scale created using RAI data in HCRS clients with full assessments. 70-items were included. 0.21 0.37 Frailty measure using HCRS CHESS Score CHESS scores from the HCRS full assessments 0.10 0.13 Frailty Index CCRS (Campitelli, 2016) Index created using Resident Assessment Instrument (RAI) data in CCRS clients with full

  • assessments. 72-items were included.

0.10 0.14

Note: All p values are <0.0001

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Unweighted frailty risk score distribution by age group

0% 10% 20% 30% 40% 50% 60% 70% 65 to 74 75 to 84 85 to 94 95 and over 0.00 to 0.09 0.10 to 0.19 0.20 to 0.29 0.30 to 0.39 0.40 to 0.49 0.50 to 0.59

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Next steps

  • Gather feedback and input on preliminary measure
  • Validate measure with stakeholders
  • Investigate further validity of measure in other sectors/community
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Acknowledgements

  • Dr. Melissa Andrews, Dalhousie University
  • Dr. Susan Bronskill, Institute for Clinical

Evaluative Sciences

  • Dr. Simon Conroy, University of Leicester
  • Dr. Robert Fowler, Sunnybrook Health

Sciences Centre

  • Dr. Andrea Hill, Sunnybrook Health Sciences

Centre

  • Dr. John Hirdes, interRAI Canada
  • Dr. David Hogan, University of Calgary
  • Dr. Colleen Maxwell, University of Waterloo
  • Dr. John Muscedere, Canadian Frailty

Network

  • Dr. Kenneth Rockwood, Dalhousie University
  • Dr. Samir Sinha, Sinai Health System
  • Dr. Olga Theou, Dalhousie University
  • Dr. Robin Urquhart, Dalhousie University
  • Dr. Hannah Wunsch, Sunnybrook Health

Sciences Centre

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Expert Advisory Group members

  • Dr. Susan Bronskill, Institute for Clinical

Evaluative Sciences

  • Dr. Simon Conroy, University of Leicester
  • Dr. David Hogan, University of Calgary
  • Megan Klammer, Vancouver Island Health

Authority

  • Dr. Colleen Maxwell, University of Waterloo
  • Dr. John Muscedere, Canadian Frailty

Network

  • Dr. Kenneth Rockwood, Dalhousie

University

  • Dr. Samir Sinha, Sinai Health System
  • Dr. Olga Theou, Dalhousie University
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Key references

  • Acute Care:

‒ Gilbert, T., et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. The Lancet. 2018. ‒ McIsaac, DI., et al. Derivation and validation of a gernealizable preoperative frailty index using population-based health administrative data. Annals of Surgery. 2018. ‒ Hubbard, RE., et al. Derivation of a frailty index from the interRAI acute care instrument. BMC Geriatrics. 2015.

  • Long-Term Care:

‒ Maclagan, LC., et al. Frailty and potentially inappropriate medication use at nursing home transition. Journal of the American Geriatrics Society. July 2017.

  • Assisted Living:

‒ Hogan, DB., et al. Comparing frailty measures in their ability to predict adverse outcome among older residents of assisted living. BMC Geriatrics. 2012.

  • Home Care:

Campitelli, MA., et al. The prevalence and health consequences of frailty in a population-based older home care cohort: A comparison of different measures. BMC Geriatrics. 2016.

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List of deficits and weights (36 condition categories)

Morbidity

  • Anemia (0.2073)
  • Cardiac (0.2285)
  • Cancer (0.2869)
  • Cerebrovascular (1.1088)
  • Diabetes (0.1343)
  • Gastrointestinal (-0.232)
  • Hypo- and hypertension

(-0.726)

  • Incontinence (0.619)
  • Renal (0.6528)
  • Respiratory (0.26)
  • Thrombosis and

embolisms (-0.128)

Function

  • Instrumental activities of

daily living (IADLs) (1.1083)

  • Arthritis and inflammation

(-0.458)

  • Movement and

immobility (0.5917)

  • Fatigue (0.5448)
  • Functional dependence

(0.8479)

  • Fractures and
  • steoporosis (0.3089)
  • Musculoskeletal (-0.626)
  • Machine dependence

(-0.489)

  • Edema (0.0869)

Sensory Loss

  • Sensory impairment

(-0.411)

Other

  • Endocrine (-0.583)
  • Epilepsy (0.2963)
  • History of medications

(-0.457)

  • Infections (0.5492)
  • Nutrition and wasting

(0.3679)

  • Pain (-0.376)
  • Organ transplants and
  • stomies (-0.785)
  • Other frailty conditions

and diseases (0.2282)

  • Other injuries (0.0833)
  • Ulcers and soft tissue

disorders (-0.544)

Cognition & Mood

  • Delirium (0.9861)
  • Delusions and

hallucinations (-0.434)

  • Dementia and Alzheimer's

(1.9785)

  • Other cognitive disorders

(0.1064)

  • Mood disorders (-0.015)

Note: All weight values are in brackets

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Unweighted Frailty Risk Score by Sex

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cihi.ca

@cihi_icis jamuah@cihi.ca @jeamuah