Department of Health Sciences, University of York, Heslington, York, United Kingdom of Great Britain and Northern Ireland.
Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Bradford Teaching Hospital NHS Foundation Trust, Bradford, West Yorkshire, United Kingdom of Great Britain and Northern Ireland.
Age Ageing. 2019 Sep 1;48(5):665-671. doi: 10.1093/ageing/afz088.
routine frailty identification and management is national policy in England, but there remains a lack of evidence on the impact of frailty on healthcare resource use. We evaluated the impact of frailty on the use and costs of general practice and hospital care.
retrospective longitudinal analysis using linked routine primary care records for 95,863 patients aged 65-95 years registered with 125 UK general practices between 2003 and 2014. Baseline frailty was measured using the electronic Frailty Index (eFI) and classified in four categories (non, mild, moderate, severe). Negative binomial regressions and ordinary least squares regressions with multilevel mixed effects were applied on the use and costs of general practice and hospital care.
compared with non-frail status, annual general practitioner consultation incidence rate ratios (IRRs) were 1.24 (95% CI: 1.21-1.27) for mild, 1.41 (95% CI: 1.35-1.47) for moderate, and 1.52 (95% CI: 1.42-1.62) for severe frailty. For emergency hospital admissions, the respective IRRs were 1.64 (95% CI 1.60-1.68), 2.45 (95% CI 2.37-2.53) and 3.16 (95% CI: 3.00-3.33). Compared with non-frail people the IRR for inpatient days was 7.26 (95% CI 6.61-7.97) for severe frailty. Using 2013/14 reference costs, extra annual cost to the healthcare system per person was £561.05 for mild, £1,208.60 for moderate and £2,108.20 for severe frailty. This equates to a total additional cost of £5.8 billion per year across the UK.
increasing frailty is associated with substantial increases in healthcare costs, driven by increased hospital admissions, longer inpatient stay, and increased general practice consultations.
在英国，常规的虚弱识别和管理是国家政策，但关于虚弱对医疗资源使用的影响仍缺乏证据。我们评估了虚弱对一般实践和医院护理使用和成本的影响。
使用 2003 年至 2014 年间在 125 家英国普通诊所注册的 95863 名 65-95 岁患者的链接常规初级保健记录进行回顾性纵向分析。使用电子虚弱指数（eFI）测量基线虚弱，并分为四个类别（非、轻度、中度、重度）。应用负二项回归和带有多层次混合效应的普通最小二乘法回归分析一般实践和医院护理的使用和成本。
与非虚弱状态相比，轻度虚弱的年度全科医生咨询发生率比（IRR）为 1.24（95%CI：1.21-1.27），中度为 1.41（95%CI：1.35-1.47），严重虚弱为 1.52（95%CI：1.42-1.62）。对于急诊住院，相应的 IRR 分别为 1.64（95%CI 1.60-1.68）、2.45（95%CI 2.37-2.53）和 3.16（95%CI：3.00-3.33）。与非虚弱人群相比，严重虚弱的住院天数 IRR 为 7.26（95%CI 6.61-7.97）。使用 2013/14 年参考成本，每人每年医疗保健系统的额外成本为轻度 561.05 英镑，中度 1208.60 英镑，严重 2108.20 英镑。这相当于英国每年额外增加 58 亿英镑的总成本。
虚弱程度的增加与医疗成本的大幅增加有关，这是由住院人数增加、住院时间延长和全科医生咨询次数增加引起的。
