Faculty of Medicine, University of Ottawa, Ottawa, Canada.
C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada.
BMC Geriatr. 2023 Mar 9;23(1):136. doi: 10.1186/s12877-023-03870-w.
Frailty is a complex age-related clinical condition that increases vulnerability to stressors. Early recognition of frailty is challenging. While primary care providers (PCPs) serve as the first point of contact for most older adults, convenient tools for identifying frailty in primary care are lacking. Electronic consultation (eConsult), a platform connecting PCPs to specialists, is a rich source of provider-to-provider communication data. Text-based patient descriptions on eConsult may provide opportunities for earlier identification of frailty. We sought to explore the feasibility and validity of identifying frailty status using eConsult data.
eConsult cases closed in 2019 and submitted on behalf of long-term care (LTC) residents or community-dwelling older adults were sampled. A list of frailty-related terms was compiled through a review of the literature and consultation with experts. To identify frailty, eConsult text was parsed to measure the frequency of frailty-related terms. Feasibility of this approach was assessed by examining the availability of frailty-related terms in eConsult communication logs, and by asking clinicians to indicate whether they can assess likelihood of frailty by reviewing the cases. Construct validity was assessed by comparing the number of frailty-related terms in cases about LTC residents with those about community-dwelling older adults. Criterion validity was assessed by comparing clinicians' ratings of frailty to the frequency of frailty-related terms.
One hundred thirteen LTC and 112 community cases were included. Frailty-related terms identified per case averaged 4.55 ± 3.95 in LTC and 1.96 ± 2.68 in the community (p < .001). Clinicians consistently rated cases with ≥ 5 frailty-related terms as highly likely of living with frailty.
The availability of frailty-related terms establishes the feasibility of using provider-to-provider communication on eConsult to identify patients with high likelihood of living with this condition. The higher average of frailty-related terms in LTC (versus community) cases, and agreement between clinician-provided frailty ratings and the frequency of frailty-related terms, support the validity of an eConsult-based approach to identifying frailty. There is potential for eConsult to be used as a case-finding tool in primary care for early recognition and proactive initiation of care processes for older patients living with frailty.
衰弱是一种与年龄相关的复杂临床状况，会增加对压力源的脆弱性。早期识别衰弱具有挑战性。虽然初级保健提供者 (PCP) 是大多数老年人的第一接触点，但在初级保健中缺乏方便的工具来识别衰弱。电子咨询 (eConsult) 是一个将 PCP 与专家联系起来的平台，它是提供者间交流数据的丰富来源。eConsult 上基于文本的患者描述可能为早期识别衰弱提供机会。我们试图探索使用 eConsult 数据识别衰弱状态的可行性和有效性。
从 2019 年关闭并代表长期护理 (LTC) 居民或社区居住的老年人提交的 eConsult 案例中进行抽样。通过文献回顾和专家咨询，编制了一组与衰弱相关的术语列表。为了识别衰弱，对 eConsult 文本进行解析以衡量与衰弱相关的术语的频率。通过检查 eConsult 通信日志中是否存在衰弱相关术语，以及询问临床医生是否可以通过审查案例来评估衰弱的可能性，来评估这种方法的可行性。通过比较关于 LTC 居民的案例与关于社区居住的老年人的案例中与衰弱相关的术语数量来评估构念效度。通过比较临床医生对衰弱的评估与与衰弱相关的术语的频率来评估标准效度。
共纳入 113 例 LTC 和 112 例社区案例。每个案例中与衰弱相关的术语平均为 LTC 中的 4.55±3.95，社区中的 1.96±2.68(p<0.001)。临床医生一致认为有≥5 个与衰弱相关的术语的案例极有可能患有衰弱。
衰弱相关术语的可用性确定了使用 eConsult 上的提供者间通信来识别患有衰弱的患者的可行性。LTC(而非社区)案例中与衰弱相关的术语的平均值较高，以及临床医生提供的衰弱评分与与衰弱相关的术语的频率之间的一致性，支持基于 eConsult 的方法识别衰弱的有效性。eConsult 有可能作为初级保健中的一种病例发现工具，用于早期识别和主动启动患有衰弱的老年患者的护理流程。
