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Development and validation of a hospital frailty risk measure using Canadian clinical administrative data.

التفاصيل البيبلوغرافية
العنوان: Development and validation of a hospital frailty risk measure using Canadian clinical administrative data.
المؤلفون: Amuah JE; 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., Molodianovitsh K; 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., Carbone S; 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., Diestelkamp N; 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., Guo Y; 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., Hogan DB; 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., Li M; 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., Maxwell CJ; 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., Muscedere J; 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., Rockwood K; 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., Sinha S; 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., Theou O; 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., Karmakar-Hore S; 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 SKarmakar-Hore@cihi.ca.
المصدر: CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne [CMAJ] 2023 Mar 27; Vol. 195 (12), pp. E437-E448.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Canadian Medical Association Country of Publication: Canada NLM ID: 9711805 Publication Model: Print Cited Medium: Internet ISSN: 1488-2329 (Electronic) Linking ISSN: 08203946 NLM ISO Abbreviation: CMAJ Subsets: MEDLINE
أسماء مطبوعة: Publication: Ottawa : Canadian Medical Association
Original Publication: [Ottawa] : The Association = L'Association, [1985]-
مواضيع طبية MeSH: Frailty*/diagnosis , Frailty*/epidemiology, Humans ; Aged ; Retrospective Studies ; Canada/epidemiology ; Hospitalization ; Risk Factors ; Hospitals ; Frail Elderly ; Geriatric Assessment
مستخلص: Background: 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).
Methods: 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.
Results: 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% ( n = 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.
Interpretation: 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.
Competing Interests: Competing interests: John Muscedere is the Scientific Director of the Canadian Frailty Network (CFN), which is funded by the government of Canada through the Networks of Centres of Excellence program. He has received grant support through CFN for frailty research. Kenneth Rockwood has asserted copyright of the Clinical Frailty Scale (CFS) through Dalhousie University’s Industry, Liaison, and Innovation Office, which has been licensed to Enanta Pharmaceuticals, Synairgen Research, Faraday Pharmaceuticals, KCR S.A., Icosavax, BioAge Labs, Biotest AG, AstraZeneca UK Limited and Qu Biologics. He has also asserted copyright (with Dr. Olga Theou) for the Pictorial Fit-Frail Scale (PFFS), which has been licensed to Congenica; use of both the CFS and PFFS is free for education, research and nonprofit health care with completion of a permission agreement stipulating users will not change, charge for or commercialize the scales. He reports personal fees from the Burnaby Division Family Practice, United Arab Emirates University, Singapore National Research Foundation, McMaster University, Chinese Medical Association, Wake Forest University Medical School, University of Omaha and Atria Institute, as well as funding from the Canadian Institutes of Health Research. He chaired the data safety monitoring board for the ADMET-II clinical trial. He is co-founder of Ardea Outcomes, which (DGI Clinical until 2021) in the last 3 years has contracts with pharmaceutical and device manufacturers (Danone, Hollister, INmune, Novartis, Takeda) on individualized outcome measurement. In 2020, on behalf of Ardea Outcomes, he attended an advisory board meeting with Nutricia on dementia. He is associate director of the Canadian Consortium on Neurodegeneration in Aging, and special advisor to the president of Cape Breton University on frailty and aging. No other competing interests were declared.
(© 2023 CMA Impact Inc. or its licensors.)
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تواريخ الأحداث: Date Created: 20230327 Date Completed: 20230329 Latest Revision: 20230330
رمز التحديث: 20230331
مُعرف محوري في PubMed: PMC10042454
DOI: 10.1503/cmaj.220926
PMID: 36972914
قاعدة البيانات: MEDLINE
الوصف
تدمد:1488-2329
DOI:10.1503/cmaj.220926