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利用电子衰弱指数识别脆弱患者:初级保健中的试点研究。

Use of the electronic Frailty Index to identify vulnerable patients: a pilot study in primary care.

机构信息

Academic Geriatric Medicine, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, Southampton.

Academic Geriatric Medicine, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Wessex, University of Southampton, and University Hospital Southampton NHS Foundation Trust, Southampton.

出版信息

Br J Gen Pract. 2017 Nov;67(664):e751-e756. doi: 10.3399/bjgp17X693089. Epub 2017 Sep 25.

Abstract

BACKGROUND

Identifying frailty is key to providing appropriate treatment for older people at high risk of adverse health outcomes. Screening tools proposed for primary care often involve additional workload. The electronic Frailty Index (eFI) has the potential to overcome this issue.

AIM

To assess the feasibility and acceptability of using the eFI in primary care.

DESIGN AND SETTING

Pilot study in one suburban primary care practice in southern England in 2016.

METHOD

Use of the eFI on the primary care TPP SystmOne database was explained to staff at the practice where a comprehensive geriatric assessment (CGA) clinic was being trialled. The practice data manager ran an eFI report for all patients ( = 6670). Date of birth was used to identify patients aged ≥75 years ( = 589). The eFI was determined for patients attending the CGA clinic ( = 18).

RESULTS

Practice staff ran the eFI reports in 5 minutes, which they reported was feasible and acceptable. The eFI range was 0.03 to 0.61 (mean 0.23) for all patients aged ≥75 years (mean 83 years, range 75 to 102 years). For CGA patients (mean 82 years, range 75 to 94 years) the eFI range was 0.19 to 0.53 (mean 0.33). Importantly, the eFI scores identified almost 12% of patients aged ≥75 years in this practice to have severe frailty.

CONCLUSION

It was feasible and acceptable to use the eFI in this pilot study. A higher mean eFI in the CGA patients demonstrated construct validity for frailty identification. Practice staff recognised the potential for the eFI to identify the top 2% of vulnerable patients for avoiding unplanned admissions.

摘要

背景

识别虚弱是为高风险不良健康结局的老年人提供适当治疗的关键。拟用于初级保健的筛查工具通常涉及额外的工作量。电子虚弱指数(eFI)有可能克服这一问题。

目的

评估在初级保健中使用 eFI 的可行性和可接受性。

设计和设置

2016 年在英格兰南部一个郊区初级保健实践中的试点研究。

方法

向正在试行综合老年评估(CGA)诊所的实践工作人员解释在初级保健 TPP SystmOne 数据库中使用 eFI。实践数据经理为所有患者(=6670)运行了一份 eFI 报告。出生日期用于识别≥75 岁的患者(=589)。为参加 CGA 诊所的患者确定了 eFI(=18)。

结果

实践工作人员在 5 分钟内运行了 eFI 报告,他们报告说这是可行和可接受的。所有≥75 岁患者的 eFI 范围为 0.03 至 0.61(平均 0.23)(平均年龄 83 岁,范围 75 至 102 岁)。对于 CGA 患者(平均 82 岁,范围 75 至 94 岁),eFI 范围为 0.19 至 0.53(平均 0.33)。重要的是,该实践中≥75 岁的患者中有近 12%的 eFI 评分被认为患有严重虚弱。

结论

在本试点研究中使用 eFI 是可行和可接受的。CGA 患者较高的平均 eFI 证明了虚弱识别的结构效度。实践工作人员认识到 eFI 有可能识别最脆弱的 2%的患者,以避免非计划性入院。

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