University of Edinburgh

DL_2022_066

Frailty describes people at high risk of developing disability or dying. Information held in GP records can help to screen older people for frailty to support targeting of earlier coordinated care. This has been automated using an electronic Frailty Index (eFI) score developed in NHS England. In the original English study, people with higher eFI scores were at higher risk of being admitted to hospital, a care home or dying. However, fewer than expected people with frailty are identified in Scotland using the eFI, probably due to differences in GP coding practices. As a result, Healthcare Improvement Scotland have created a ‘modified eFI’. In this study we will test its effectiveness, by calculating original and modified eFI scores for people aged over 65 years old in 2017. We will then compare how well each score related to outcomes like hospital admission and death over the last 5 years. This is important for GPs to have confidence in the use of this modified score, which has not been tested across a wide population before._x000D_

The electronic frailty index (eFI) is the only validated routine data frailty measure incorporated into UK electronic health records. It was developed in a study of 415,000 English patients aged 65-95 years old using up to 2,000 data points to generate a score from GP records. These include presence of specific diseases, symptoms, disabilities and prescriptions. Higher eFI scores are associated with an increased risk of hospital admission, needing a care home, or dying. Following this work, the eFI was built into UK GP systems to trigger earlier assessments in older people. However, Healthcare Improvement Scotland (HIS) identified some unexpected under-identification of frailty using the eFI in Scotland, noting differences in coding patterns compared to England. HIS therefore created a ‘modified eFI’, including more GP codes to improve identification of frailty, and made this score available to Scottish GPs via a national data platform. However, this modified eFI has not been robustly tested as a predictor of important patient outcomes yet is used by GPs in Scotland. We propose the first population-level comparison of these scores, to report the validity of the modified eFI. Our aim is to improve confidence in the use of the eFI by Scottish GPs to help drive better care for older people.

Public Health Research

13/06/2023

De-Personalised

TRE