Department of General Internal Medicine, Johns Hopkins University School of Medicine, 624 N Broadway, Baltimore, MD, 21205, USA.
Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
BMC Geriatr. 2017 Oct 25;17(1):248. doi: 10.1186/s12877-017-0645-7.
Geriatric syndromes, including frailty, are common in older adults and associated with adverse outcomes. We compared patients described in clinical notes as "frail" to other older adults with respect to geriatric syndrome burden and healthcare utilization.
We conducted a retrospective cohort study on 18,341 Medicare Advantage enrollees aged 65+ (members of a large nonprofit medical group in Massachusetts), analyzing up to three years of administrative claims and structured and unstructured electronic health record (EHR) data. We determined the presence of ten geriatric syndromes (falls, malnutrition, dementia, severe urinary control issues, absence of fecal control, visual impairment, walking difficulty, pressure ulcers, lack of social support, and weight loss) from claims and EHR data, and the presence of frailty descriptions in clinical notes with a pattern-matching natural language processing (NLP) algorithm.
Of the 18,341 patients, we found that 2202 (12%) were described as "frail" in clinical notes. "Frail" patients were older (82.3 ± 6.8 vs 75.9 ± 5.9, p < .001) and had higher rates of healthcare utilization, including number of inpatient hospitalizations and emergency department visits, than the rest of the population (p < .001). "Frail" patients had on average 4.85 ± 1.72 of the ten geriatric syndromes studied, while non-frail patients had 2.35 ± 1.71 (p = .013). Falls, walking difficulty, malnutrition, weight loss, lack of social support and dementia were more highly correlated with frailty descriptions. The most common geriatric syndrome pattern among "frail" patients was a combination of walking difficulty, lack of social support, falls, and weight loss.
Patients identified as "frail" by providers in clinical notes have higher rates of healthcare utilization and more geriatric syndromes than other patients. Certain geriatric syndromes were more highly correlated with descriptions of frailty than others.
老年综合征，包括虚弱，在老年人中很常见，与不良结局有关。我们比较了临床病历中描述为“虚弱”的患者与其他老年患者的老年综合征负担和医疗保健利用情况。
我们对马萨诸塞州一家大型非营利性医疗集团的 18341 名 Medicare Advantage 参保者（年龄在 65 岁及以上）进行了回顾性队列研究，分析了长达三年的行政索赔和结构化及非结构化电子健康记录（EHR）数据。我们从索赔和 EHR 数据中确定了十种老年综合征（跌倒、营养不良、痴呆、严重尿控问题、无法控制粪便、视力障碍、行走困难、压疮、缺乏社会支持和体重减轻）的存在情况，并使用模式匹配自然语言处理（NLP）算法从临床病历中确定了虚弱描述的存在情况。
在 18341 名患者中，我们发现有 2202 名（12%）在临床病历中被描述为“虚弱”。“虚弱”患者年龄更大（82.3±6.8 岁 vs 75.9±5.9 岁，p<.001），医疗保健利用率更高，包括住院和急诊就诊次数，均高于其他人群（p<.001）。“虚弱”患者平均有 4.85±1.72 种研究中的十种老年综合征，而非虚弱患者有 2.35±1.71 种（p=.013）。跌倒、行走困难、营养不良、体重减轻、缺乏社会支持和痴呆与虚弱描述的相关性更高。“虚弱”患者中最常见的老年综合征模式是行走困难、缺乏社会支持、跌倒和体重减轻的组合。
临床病历中被医生标记为“虚弱”的患者的医疗保健利用率和老年综合征发生率高于其他患者。某些老年综合征与虚弱描述的相关性高于其他综合征。
