Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS.
Canadian Institute for Health Information (Amuah, Molodianovitsh, Carbone, Diestelkamp, Guo, Li, Karmakar-Hore); School of Epidemiology and Public Health (Amuah), University of Ottawa, Ottawa, Ont.; Institute of Health Policy, Management and Evaluation (Carbone), University of Toronto, Toronto, Ont.; School of Public Health Sciences (Guo, Maxwell), University of Waterloo, Waterloo, Ont.; Division of Geriatric Medicine (Hogan), Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alta.; School of Pharmacy (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Critical Care Medicine (Muscedere), Queen's University; Canadian Frailty Network (Muscedere), Kingston, Ont.; Division of Geriatric Medicine, Department of Medicine (Rockwood), Dalhousie University, Halifax, NS; Division of Geriatric Medicine (Sinha), Department of Medicine, University of Toronto; National Institute on Ageing (Sinha), Ryerson University, Toronto, Ont.; School of Physiotherapy and Division of Geriatric Medicine (Theou), Dalhousie University, Halifax, NS
CMAJ. 2023 Mar 27;195(12):E437-E448. doi: 10.1503/cmaj.220926.
Accessible measures specific to the Canadian context are needed to support health system planning for older adults living with frailty. We sought to develop and validate the Canadian Institute for Health Information (CIHI) Hospital Frailty Risk Measure (HFRM).
Using CIHI administrative data, we conducted a retrospective cohort study involving patients aged 65 years and older who were discharged from Canadian hospitals from Apr. 1, 2018, to Mar. 31, 2019. We used a 2-phase approach to develop and validate the CIHI HFRM. The first phase, construction of the measure, was based on the deficit accumulation approach (identification of age-related conditions using a 2-year look-back). The second phase involved refinement into 3 formats (continuous risk score, 8 risk groups and binary risk measure), with assessment of their predictive validity for several frailty-related adverse outcomes using data to 2019/20. We assessed convergent validity with the United Kingdom Hospital Frailty Risk Score.
The cohort consisted of 788 701 patients. The CIHI HFRM included 36 deficit categories and 595 diagnosis codes that cover morbidity, function, sensory loss, cognition and mood. The median continuous risk score was 0.111 (interquartile range 0.056-0.194, equivalent to 2-7 deficits); 35.1% ( = 277 000) of the cohort were found at risk of frailty (≥ 6 deficits). The CIHI HFRM showed satisfactory predictive validity and reasonable goodness-of-fit. For the continuous risk score format (unit = 0.1), the hazard ratio (HR) for 1-year risk of death was 1.39 (95% confidence interval [CI] 1.38-1.41), with a C-statistic of 0.717 (95% CI 0.715-0.720); the odds ratio for high users of hospital beds was 1.85 (95% CI 1.82-1.88), with a C-statistic of 0.709 (95% CI 0.704-0.714), and the HR of 90-day admission to long-term care was 1.91 (95% CI 1.88-1.93), with a C-statistic of 0.810 (95% CI 0.808-0.813). Compared with the continuous risk score, using a format of 8 risk groups had similar discriminatory ability and the binary risk measure had slightly weaker performance.
The CIHI HFRM is a valid tool showing good discriminatory power for several adverse outcomes. The tool can be used by decision-makers and researchers by providing information on hospital-level prevalence of frailty to support system-level capacity planning for Canada's aging population.
需要有针对加拿大国情的可获取的衡量标准来支持虚弱老年人的卫生系统规划。我们旨在开发和验证加拿大健康信息研究所（CIHI）医院衰弱风险衡量标准（HFRM）。
使用 CIHI 行政数据，我们进行了一项回顾性队列研究，纳入了 2018 年 4 月 1 日至 2019 年 3 月 31 日期间从加拿大医院出院的年龄在 65 岁及以上的患者。我们采用两阶段方法来开发和验证 CIHI HFRM。第一阶段，构建措施，基于缺陷积累方法（使用 2 年回顾确定与年龄相关的情况）。第二阶段包括细化为 3 种格式（连续风险评分、8 个风险组和二进制风险衡量标准），并使用 2019/20 年的数据评估其对几种与衰弱相关的不良结局的预测有效性。我们使用英国医院衰弱风险评分来评估收敛有效性。
队列包括 788701 名患者。CIHI HFRM 包括 36 个缺陷类别和 595 个诊断代码，涵盖了发病率、功能、感觉丧失、认知和情绪。连续风险评分中位数为 0.111（四分位间距 0.056-0.194，相当于 2-7 个缺陷）；35.1%（=277000）的患者有衰弱风险（≥6 个缺陷）。CIHI HFRM 显示出令人满意的预测有效性和合理的拟合优度。对于连续风险评分格式（单位=0.1），1 年死亡风险的风险比（HR）为 1.39（95%置信区间 [CI] 1.38-1.41），C 统计量为 0.717（95% CI 0.715-0.720）；住院床位高使用率的优势比为 1.85（95% CI 1.82-1.88），C 统计量为 0.709（95% CI 0.704-0.714），90 天入住长期护理的 HR 为 1.91（95% CI 1.88-1.93），C 统计量为 0.810（95% CI 0.808-0.813）。与连续风险评分相比，使用 8 个风险组的格式具有相似的区分能力，而二进制风险衡量标准的性能略弱。
CIHI HFRM 是一种有效的工具，对几种不良结局具有良好的区分能力。决策者和研究人员可以使用该工具，通过提供医院层面衰弱患病率的信息，支持加拿大老龄化人口的系统层面能力规划。
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