Identifying Frailty in Primary Care: Implementation of an Electronic Medical Record-based Frailty Index

识别初级保健中的衰弱：实施基于电子病历的衰弱指数

• 批准号: 10408119
• 负责人: Kathryn Callahan
• 金额: $ 23.15万
• 依托单位: WAKE FOREST UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10408119
• 关键词: Academic Medical Centers; Address; Admission activity; Adoption; Adult; Advisory Committees; Age; Aging; Ambulatory Care; Attitude; Award; Baptist Church; British; Capsicum; Caring; Cessation of life; Classification; Clinical; Clinical Informatics; Clinical Medicine; Competence; Computerized Medical Record; Congestive Heart Failure; Data; Decision Making; Development Plans; Educational Intervention; Effectiveness; Elderly; Enrollment; Environment; Evidence based intervention; Foundations; Frail Elderly; Future; Geriatrics; Goals; Guidelines; Health; Health Care Costs; Health Promotion; Health system; Healthcare; Healthcare Systems; Hospitalization; Institutes; Intervention; Intervention Studies; Intervention Trial; Knowledge; Learning; Measures; Mediating; Medical; Medicare; Mentors; Modeling; National Health Services; Outcome; Patient Self-Report; Patients; Personal Satisfaction; Physical Function; Pilot Projects; Population; Predictive Value; Primary Health Care; Provider; Quality of life; Randomized; Readiness; Research; Research Personnel; Research Project Grants; Resources; Risk; Savings; Site; Skilled Nursing Facilities; Social Functioning; Social support; Societies; System; Testing; Time; Training; Translating; Translational Research; United Kingdom; Visit; Work; acceptability and feasibility; base; care costs; care outcomes; care providers; career; career development; clinical implementation; clinical practice; cognitive function; disability; experience; fall injury; fall risk; forest; frailty; hospital readmission; implementation evaluation; implementation intervention; implementation science; implementation trial; improved; indexing; innovation; interest; medical schools; mortality; next generation; prognostic indicator; programs; response; skills; treatment as usual

Project Summary This Beeson award seeks to equip the candidate, Dr. Kathryn E. Callahan, with the expertise to become an independent investigator to advance use of aging-related metrics and interventions to promote health, function, and quality of life in frail and at-risk older adults. Frailty is prevalent among older adults, and associated with negative outcomes, including hospitalizations, mobility disability, admission to skilled nursing facilities, and mortality. Despite efforts to define and quantify frailty, time and resource constraints limit the feasibility of frailty measures in clinical practice. Dr. Callahan's preliminary work supports the feasibility of translating anEMR- based Frailty Index, or eFI – into the Wake Forest Baptist Health (WFBH) EMR, and demonstrates an initial association between eFI score and hospitalizations and mortality. The proposed research project represents critical next steps: (1) to adapt and refine the eFI using ambulatory care data, (2) assess its predictive value for healthcare outcomes for older adults, and (3) conduct a pilot of implementation in Medicare Shared Savings Program/Next Generation Accountable Care Organization primary care practices, to collect critical data regarding feasibility, acceptability, and effectiveness. The scientific goal is to develop and implement an index to define a population of frail older adults who would benefit from personalized evidence-based interventions. This work is essential to inform larger-scale implementation trials of interventions to mediate negative and costly health outcomes for frail older adults. We hypothesize that self-report and functional data from Annual Wellness Visits (AWVs) in the EMR will further refine the predictive value of the eFI; and that implementation of the eFI will be feasible and acceptable. This project is supported by engaged mentors (Drs. Williamson and Boustani) and a highly interactive, inter-disciplinary advisory committee (Drs. Foley, Rejeski, and Pajewski) whose expertise and complementary skills are a noteworthy asset to this project. We propose the adaptation and refinement of the eFI within the WFBH EMR, using data from older adults enrolled in the WFBH MSSP/ Next Gen ACO (Aim 1): we will integrate AWV data, and refine the predictive value of eFI scores in this population. We will then conduct a pilot study implementing the adapted eFI score in six MSSP/Next Gen ACO primary care practices, and follow health outcomes. The research proposed aligns with an NIA priority to improve the health, well-being, and independence of adults as they age. It will also provide essential training for the candidate, who will establish expertise in implementation science, achieve fluency in clinical informatics, and develop competencies in leading implementation trials. This approach provides the ideal platform to advance the candidate's career as an independent investigator and provides the foundation to establish frailty metrics in practice, leveraging the learning health system to implement interventions to improve health and function.

项目总结

项目成果

Automated Frailty Screening At-Scale for Pre-Operative Risk Stratification Using the Electronic Frailty Index.

• DOI: 10.1111/jgs.17027
• 发表时间: 2021-05
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Callahan KE;Clark CJ;Edwards AF;Harwood TN;Williamson JD;Moses AW;Willard JJ;Cristiano JA;Meadows K;Hurie J;High KP;Meredith JW;Pajewski NM
• 通讯作者: Pajewski NM

Predicting Future Mobility Limitation in Older Adults: A Machine Learning Analysis of Health ABC Study Data.

预测老年人未来的行动限制：Health ABC 研究数据的机器学习分析。

• DOI: 10.1093/gerona/glab269
• 发表时间: 2022
• 期刊: The journals of gerontology. Series A, Biological sciences and medical sciences
• 作者: Speiser,JaimeL;Callahan,KathrynE;Ip,EdwardH;Miller,MichaelE;Tooze,JanetA;Kritchevsky,StephenB;Houston,DeniseK
• 通讯作者: Houston,DeniseK

Introducing Aquifer Geriatrics, the American Geriatrics Society National Online Curriculum.

• DOI: 10.1111/jgs.15813
• 发表时间: 2019-04
• 期刊: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
• 影响因子: 6.3
• 作者: Sehgal, Mandi;Syed, Quratulain;Callahan, Kathryn E.;Powers, Becky B.;Eleazer, G. Paul;Gleason, Lauren L.;Ramaswamy, Ravishankar;Sauvigne, Karen;Leipzig, Rosanne M.;Shah, Amit
• 通讯作者: Shah, Amit

Big 'G' and Little 'g' Geriatrics Education for Physicians.

• DOI: 10.1111/jgs.14996
• 发表时间: 2017-10
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Callahan KE;Tumosa N;Leipzig RM
• 通讯作者: Leipzig RM

Embedding Function into Health Care.

将功能融入医疗保健。

• DOI: 10.1111/jgs.16902
• 发表时间: 2021
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Ling,ShariM;Lipp,MichaelJ;Schreiber,Michelle
• 通讯作者: Schreiber,Michelle