The University of Southampton
University of Southampton Institutional Repository

Development and validation of a hospital frailty risk score focusing on older people in acute care settings using electronic hospital records: an observational study

Development and validation of a hospital frailty risk score focusing on older people in acute care settings using electronic hospital records: an observational study
Development and validation of a hospital frailty risk score focusing on older people in acute care settings using electronic hospital records: an observational study
Background: older people are increasing users of healthcare globally; the aim of this study was to determine if older people with characteristics of frailty and at risk of adverse healthcare outcomes could be identified using routinely collected data.

Methods: a three-step approach was used to develop and validate a Hospital Frailty Risk Score from ICD-10 diagnostic codes. First, we carried out a cluster analysis to identify a group of hospitalised older people (75 years+) with high resource use and diagnoses associated with frailty. Second, we created a Hospital Frailty Risk Score based on ICD-10 codes that characterised this group. Third, in separate cohorts, we tested how well the score predicted adverse outcomes, and whether it identified similar groups as other frailty tools.

Findings: in the development cohort (n = 22,139), older people with frailty diagnoses formed a distinct group, and had higher non-elective hospital use. In a national validation cohort (n = 1,013,590), compared to patients with the lowest 40%, patients with the highest 20% of Hospital Frailty Risk Scores had increased odds of 30-day mortality (odds ratio 1·71, 95% confidence interval 1·68 to 1·75), long length of stay (OR 6·03, 95% CI 5·92 to 6·10) and 30-day readmission (OR 1·48, 95% CI 1·46 to 1·50). Model discrimination (c-statistic) between individuals for these three outcomes was 0·60, 0·68 and 0·56, respectively. The Hospital Frailty Risk Score exhibited fair or moderate overlap in the identification of frailty with the Fried or Rockwood frailty scales respectively.

Interpretation: the Hospital Frailty Risk Score provides hospitals and health systems with a low cost, systematic way to screen for frailty, identifying a group of hospitalised patients at greater risk of adverse outcomes for whom a frailty-attuned approach might be useful.

Funding: National Institute for Health Research.
0140-6736
1775-1782
Gilbert, Thomas P.
a48f98e3-6a47-4b46-9054-610e54657d5f
Neuburger, Jenny
0f212f87-f87c-44f1-96a3-e9b1619d4c54
Kraindler, Joshua
61ab1dbf-f2d0-4282-aa79-3c4c6ce850c0
Keeble, Eilis
20e82708-71f4-4216-9d8a-21eea95718e7
Smith, Paul
5971135c-98d0-47e0-9f40-94085befbd20
Ariti, Cono
713b0365-65a5-4062-94a0-b02f453bc26c
Arora, Sandeepa
e5e8a251-6b7e-4985-acea-b50e4beb636b
Street, Andrew
dbba1214-317d-45f3-a35d-40b15fc96120
Parker, Stuart
17ef5cb5-c646-4ea5-8197-7742cb32e271
Roberts, Helen
5ea688b1-ef7a-4173-9da0-26290e18f253
Bardsley, Martin
b0971145-6fe5-435f-99cf-5e32608f567d
Conroy, Simon
7ca24494-cca8-4846-b5ea-f79d1f7dedfa
Gilbert, Thomas P.
a48f98e3-6a47-4b46-9054-610e54657d5f
Neuburger, Jenny
0f212f87-f87c-44f1-96a3-e9b1619d4c54
Kraindler, Joshua
61ab1dbf-f2d0-4282-aa79-3c4c6ce850c0
Keeble, Eilis
20e82708-71f4-4216-9d8a-21eea95718e7
Smith, Paul
5971135c-98d0-47e0-9f40-94085befbd20
Ariti, Cono
713b0365-65a5-4062-94a0-b02f453bc26c
Arora, Sandeepa
e5e8a251-6b7e-4985-acea-b50e4beb636b
Street, Andrew
dbba1214-317d-45f3-a35d-40b15fc96120
Parker, Stuart
17ef5cb5-c646-4ea5-8197-7742cb32e271
Roberts, Helen
5ea688b1-ef7a-4173-9da0-26290e18f253
Bardsley, Martin
b0971145-6fe5-435f-99cf-5e32608f567d
Conroy, Simon
7ca24494-cca8-4846-b5ea-f79d1f7dedfa

Gilbert, Thomas P., Neuburger, Jenny, Kraindler, Joshua, Keeble, Eilis, Smith, Paul, Ariti, Cono, Arora, Sandeepa, Street, Andrew, Parker, Stuart, Roberts, Helen, Bardsley, Martin and Conroy, Simon (2018) 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, 391 (10132), 1775-1782, [D-17-07092R2]. (doi:10.1016/S0140-6736(18)30668-8).

Record type: Article

Abstract

Background: older people are increasing users of healthcare globally; the aim of this study was to determine if older people with characteristics of frailty and at risk of adverse healthcare outcomes could be identified using routinely collected data.

Methods: a three-step approach was used to develop and validate a Hospital Frailty Risk Score from ICD-10 diagnostic codes. First, we carried out a cluster analysis to identify a group of hospitalised older people (75 years+) with high resource use and diagnoses associated with frailty. Second, we created a Hospital Frailty Risk Score based on ICD-10 codes that characterised this group. Third, in separate cohorts, we tested how well the score predicted adverse outcomes, and whether it identified similar groups as other frailty tools.

Findings: in the development cohort (n = 22,139), older people with frailty diagnoses formed a distinct group, and had higher non-elective hospital use. In a national validation cohort (n = 1,013,590), compared to patients with the lowest 40%, patients with the highest 20% of Hospital Frailty Risk Scores had increased odds of 30-day mortality (odds ratio 1·71, 95% confidence interval 1·68 to 1·75), long length of stay (OR 6·03, 95% CI 5·92 to 6·10) and 30-day readmission (OR 1·48, 95% CI 1·46 to 1·50). Model discrimination (c-statistic) between individuals for these three outcomes was 0·60, 0·68 and 0·56, respectively. The Hospital Frailty Risk Score exhibited fair or moderate overlap in the identification of frailty with the Fried or Rockwood frailty scales respectively.

Interpretation: the Hospital Frailty Risk Score provides hospitals and health systems with a low cost, systematic way to screen for frailty, identifying a group of hospitalised patients at greater risk of adverse outcomes for whom a frailty-attuned approach might be useful.

Funding: National Institute for Health Research.

Text
preprint Lancet accepted - Accepted Manuscript
Download (419kB)
Text
PIIS0140673618306688 - Version of Record
Download (346kB)

More information

Accepted/In Press date: 8 March 2018
e-pub ahead of print date: 26 April 2018
Published date: 5 May 2018
Additional Information: invited commentary by Prof Rockwood on the article was also published at the same time

Identifiers

Local EPrints ID: 418829
URI: http://eprints.soton.ac.uk/id/eprint/418829
ISSN: 0140-6736
PURE UUID: 7ca1a577-8c55-4914-a03f-70b65c5acdf2
ORCID for Helen Roberts: ORCID iD orcid.org/0000-0002-5291-1880

Catalogue record

Date deposited: 23 Mar 2018 17:30
Last modified: 16 Aug 2024 04:02

Export record

Altmetrics

Contributors

Author: Thomas P. Gilbert
Author: Jenny Neuburger
Author: Joshua Kraindler
Author: Eilis Keeble
Author: Paul Smith
Author: Cono Ariti
Author: Sandeepa Arora
Author: Andrew Street
Author: Stuart Parker
Author: Helen Roberts ORCID iD
Author: Martin Bardsley
Author: Simon Conroy

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×