Gilbert T, et al. - Researchers ascertained if older people with characteristics of frailty and who were at risk of adverse health-care outcomes could be identified using routinely collected data. Hospitals and health systems were provided by the Hospital Frailty Risk Score with a low-cost, systematic way to screen for frailty and identified a group of patients who were at greater risk of adverse outcomes and for whom a frailty-attuned approach could be useful.

Methods

• Experts used a 3-step approach to develop and validate a Hospital Frailty Risk Score from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes.
• To identify a group of older people (≥75 years) admitted to hospital who had high resource use and diagnoses associated with frailty they first, carried out a cluster analysis.
• Second, they created a Hospital Frailty Risk Score based on ICD-10 codes that characterised this group.
• Third, they tested in separate cohorts, how well the score predicted adverse outcomes and if it identified similar groups as other frailty tools.

Results

• Findings suggested that in the development cohort (n=22,139), older people with frailty diagnoses formed a distinct group and had higher non-elective hospital use (33·6 bed-days over 2 years vs 23·0 bed-days for the group with the next highest number of bed-days).
• As per data, in the national validation cohort (n=1,013,590), vs the 429,762 (42·4%) patients with the lowest risk scores, the 202,718 (20·0%) patients with the highest Hospital Frailty Risk Scores had increased odds of 30-day mortality (odds ratio 1·71, 95% CI 1·68-1·75), long hospital stay (6·03, 5·92-6·10), and 30-day readmission (1·48, 1·46–1·50).
• Results demonstrated the c statistics (ie, model discrimination) between individuals for these 3 outcomes to be 0·60, 0·68, and 0·56, respectively.
• Fair overlap with dichotomised Fried and Rockwood scales (kappa scores 0·22, 95% CI 0·15–0·30 and 0·30, 0·22–0·38, respectively) was demonstrated by the Hospital Frailty Risk Score and moderate agreement with the Rockwood Frailty Index (Pearson's correlation coefficient 0·41, 95% CI 0·38–0·47).