Predicting readmission and death after hospital discharge: a comparison of conventional frailty measurement with an electronic health record-based score.

BACKGROUND

frailty measurement may identify patients at risk of decline after hospital discharge, but many measures require specialist review and/or additional testing.

OBJECTIVE

to compare validated frailty tools with routine electronic health record (EHR) data at hospital discharge, for associations with readmission or death.

DESIGN

observational cohort study.

SETTING

hospital ward.

SUBJECTS

consented cardiology inpatients ≥70 years old within 24 hours of discharge.

METHODS

patients underwent Fried, Short Physical Performance Battery (SPPB), PRISMA-7 and Clinical Frailty Scale (CFS) assessments. An EHR risk score was derived from the proportion of 31 possible frailty markers present. Electronic follow-up was completed for a primary outcome of 90-day readmission or death. Secondary outcomes were mortality and days alive at home ('home time') at 12 months.

RESULTS

in total, 186 patients were included (79 ± 6 years old, 64% males). The primary outcome occurred in 55 (30%) patients. Fried (hazard ratio [HR] 1.47 per standard deviation [SD] increase, 95% confidence interval [CI] 1.18-1.81, P < 0.001), CFS (HR 1.24 per SD increase, 95% CI 1.01-1.51, P = 0.04) and EHR risk scores (HR 1.35 per SD increase, 95% CI 1.02-1.78, P = 0.04) were independently associated with the primary outcome after adjustment for age, sex and co-morbidity, but the SPPB and PRISMA-7 were not. The EHR risk score was independently associated with mortality and home time at 12 months.

CONCLUSIONS

frailty measurement at hospital discharge identifies patients at risk of poorer outcomes. An EHR-based risk score appeared equivalent to validated frailty tools and may be automated to screen patients at scale, but this requires further validation.