基于电子健康记录的电子衰弱指数验证：eFRAGICAP 指数。
Validation of an electronic frailty index with electronic health records: eFRAGICAP index.
机构信息
Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes 587, Àtic, 08007, Barcelona, Spain.
Gerència Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain.
出版信息
BMC Geriatr. 2022 May 7;22(1):404. doi: 10.1186/s12877-022-03090-8.
OBJECTIVE
To create an electronic frailty index (eFRAGICAP) using electronic health records (EHR) in Catalunya (Spain) and assess its predictive validity with a two-year follow-up of the outcomes: homecare need, institutionalization and mortality in the elderly. Additionally, to assess its concurrent validity compared to other standardized measures: the Clinical Frailty Scale (CFS) and the Risk Instrument for Screening in the Community (RISC).
METHODS
The eFRAGICAP was based on the electronic frailty index (eFI) developed in United Kingdom, and includes 36 deficits identified through clinical diagnoses, prescriptions, physical examinations, and questionnaires registered in the EHR of primary health care centres (PHC). All subjects > 65 assigned to a PHC in Barcelona on 1st January, 2016 were included. Subjects were classified according to their eFRAGICAP index as: fit, mild, moderate or severe frailty. Predictive validity was assessed comparing results with the following outcomes: institutionalization, homecare need, and mortality at 24 months. Concurrent validation of the eFRAGICAP was performed with a sample of subjects (n = 333) drawn from the global cohort and the CFS and RISC. Discrimination and calibration measures for the outcomes of institutionalization, homecare need, and mortality and frailty scales were calculated.
RESULTS
253,684 subjects had their eFRAGICAP index calculated. Mean age was 76.3 years (59.5% women). Of these, 41.1% were classified as fit, and 32.2% as presenting mild, 18.7% moderate, and 7.9% severe frailty. The mean age of the subjects included in the validation subsample (n = 333) was 79.9 years (57.7% women). Of these, 12.6% were classified as fit, and 31.5% presented mild, 39.6% moderate, and 16.2% severe frailty. Regarding the outcome analyses, the eFRAGICAP was good in the detection of subjects who were institutionalized, required homecare assistance, or died at 24 months (c-statistic of 0.841, 0.853, and 0.803, respectively). eFRAGICAP was also good in the detection of frail subjects compared to the CFS (AUC 0.821) and the RISC (AUC 0.848).
CONCLUSION
The eFRAGICAP has a good discriminative capacity to identify frail subjects compared to other frailty scales and predictive outcomes.
目的
使用电子健康记录（EHR）在加泰罗尼亚（西班牙）创建电子脆弱指数（eFRAGICAP），并通过对以下结果的两年随访来评估其预测有效性：居家护理需求、机构化和老年人的死亡率。此外，评估其与其他标准化措施的同时效度：临床脆弱性量表（CFS）和社区筛查风险工具（RISC）。
方法
eFRAGICAP 基于英国开发的电子脆弱指数（eFI），包括通过临床诊断、处方、体检和在初级保健中心（PHC）的电子病历中登记的问卷确定的 36 个缺陷。所有于 2016 年 1 月 1 日被分配到巴塞罗那的 PHC 的 >65 岁的患者都被纳入。根据其 eFRAGICAP 指数将患者分类为：健康、轻度、中度或重度脆弱。通过与以下结果比较来评估预测有效性：24 个月时的机构化、居家护理需求和死亡率。使用从全球队列和 CFS 及 RISC 中抽取的样本（n=333）对 eFRAGICAP 进行同时效验证。计算了对机构化、居家护理需求和死亡率以及脆弱性量表的结果的区分和校准措施。
结果
253684 名患者计算了其 eFRAGICAP 指数。平均年龄为 76.3 岁（59.5%为女性）。其中，41.1%被归类为健康，32.2%为轻度，18.7%为中度，7.9%为重度脆弱。纳入验证子样本（n=333）的患者的平均年龄为 79.9 岁（57.7%为女性）。其中，12.6%被归类为健康，31.5%为轻度，39.6%为中度，16.2%为重度脆弱。关于结果分析，eFRAGICAP 在检测 24 个月时需要机构化、居家护理援助或死亡的患者方面表现良好（c 统计量分别为 0.841、0.853 和 0.803）。与 CFS（AUC 0.821）和 RISC（AUC 0.848）相比，eFRAGICAP 也能很好地检测出脆弱的患者。
结论
与其他脆弱性量表和预测结果相比，eFRAGICAP 具有良好的区分能力，可用于识别脆弱的患者。
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