New Frailty Measurement Tool Could Help Identify Vulnerable Older Adults in Epic

Investigators at Mass General Brigham have developed a tool that can identify older adults at increased risk of emergency healthcare needs, rehospitalization or death. The tool measured patient frailty, an aging-related syndrome, by integrating the health records of more than 500,000 individuals collected across multiple hospitals at Mass General Brigham. These findings, published in Journal of the American Geriatric Society, could help clinicians care for high-risk patients even without the availability of comprehensive primary care records.

“Frailty is associated with higher risk of falls, hospitalization and potentially preventable healthcare system costs,” said co-first author Bharati Kochar MD, MS, of the Gastroenterology Unit and the Mongan Institute Center for Aging and Serious Illness at Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare system. “But it can be challenging to measure frailty using routinely collected data in electronic health records (EHRs). Patients often receive care across multiple healthcare systems, which can lead to incomplete information on aging-related health deficits. Our study demonstrates we can overcome these challenges to help identify patients at risk for adverse health outcomes.”

In this study, researchers examined EHR data from patients who received care at hospitals within the Mass General Brigham system. The analysis included patients aged 60 and above, who had experienced between 1-2 outpatient visits within a 2- or 3-year period prior to 2017, as well as a sub-cohort that received primary care within the same time window. The investigators developed a frailty index that classified patients as robust, pre-frail, frail or very frail based on the presence or absence of 31 age-related health deficits in their EHR data.

Among 518,449 patients with a mean age of 71.94 years, the research team identified 72.9% as robust, 15.8% as pre-frail, 6.9% as frail and 2.8% as very frail. Compared to robust individuals, very frail individuals had increased rates of death and hospital readmission within a 90-day window. Rates of worse outcomes increased from pre-frail to very frail individuals, relative to robust individuals.

“Our study shows that frailty can be measured in EHRs, even when data is incomplete,” said senior author Ariela R. Orkaby, MD, MPH, of the Division of Aging at Brigham and Women’s Hospital. “For hospitals caring for an older and sicker population, an automated frailty tool, such as the Mass General Brigham-Electronic Frailty Index, is a rapid way to identify patients at highest risk of an adverse health outcome. We hope that this tool will help improve care of all older adults entering the healthcare system.”

The authors note that while the work was made possible through cross-system collaboration at Mass General Brigham, the tool could also help other health systems identify older adults at risk of outcomes that adversely impact overall health and well-being.

Authorship: In addition to Kochar, Mass General Brigham authors include David Cheng, Elizabeth Araka, Christine S. Ritchie, and Ariela R. Orkaby. Additional authors include Hanna-Riikka Lehto, Nelia Jain, and Rachelle Bernacki.

Disclosures: Kochar reports consulting fees for Pfizer, Inc & Bristol-Meyers Squibb, relationships ended. Jain is now affiliated with Devoted Health, Waltham, Massachusetts, USA.

Funding: National Institutes of Health (R03AG074059, K76AG083309, R03AG060169, IK2CX001800, P30AG031679, R01AG081287), Paivikki and Sakari Sohlberg Foundation.

Paper cited: Kochar B et al. “Application of an electronic frailty index to identify high risk older adults using electronic health record data” Journal of the American Geriatrics Society DOI: 10.1111/jgs.19389