Creating and Validating a Claim-based Indicator of Frailty

描述（由申请人提供）：Fried描述了一种基于心血管健康研究中个体队列观察的脆弱表型。当5个表型标准中的3个表明能量受损时，即握力低、能量低、清醒速度减慢、体力活动低和无意中体重减轻时，这种表型就会出现。她的合作者在后来的工作中将虚弱概念化为一种医学综合症。我们建议仅使用行政索赔数据来识别虚弱的个人。鉴于索赔数据的普遍性，一个具有良好敏感性和特异性的脆弱指标将被广泛使用。通过行政数据确定的虚弱可以作为一个暴露变量，以了解虚弱个体的健康结果。它可以作为一个结果变量，用于评估旨在预防或延缓虚弱的干预措施的影响，或评估作为住院或手术等干预措施的不希望的结果的虚弱。基于索赔的指标也可以用作治疗有效性模型中的效果修正器，在治疗相关反应因虚弱而预期存在差异的情况下。我们的目标是开发一个工具，我们将其称为基于索赔的脆弱性指标（CFI），它可以仅使用索赔数据生成。这将通过将现有的脆弱性量表转换为具有适当验证的基于索赔的工具来开发。我们将通过证明治疗效果的异质性和使用干预措施治疗主动脉瓣狭窄（经导管手术和开放式手术）的益处来探讨CFI的价值。相关性虚弱是一种临床综合征，其特征是握力低、能量低、清醒速度慢、体力活动少和无意中体重减轻。当使用观察性数据进行研究时，仅通过行政索赔数据来衡量虚弱的工具将对探索虚弱个体的治疗效果具有很高的价值。

DESCRIPTION (provided by applicant): Fried described a frailty phenotype based upon observation of the cohort of individuals enrolled in the Cardiovascular Health Study. This phenotype is manifest when 3 of the 5 phenotypic criteria indicating compromised energetics, namely, low grip strength, low energy, slowed waking speed, low physical activity, and unintentional weight loss are present. Later work, by her collaborators, conceptualized frailty as a medical syndrome. We propose to identify individuals with frailty using only administrative claims data. Given the ubiquity of claims data, an indicator of frailty with good sensitivity and specificity would be widely used. Frailty identified with administrative data may be used as an exposure variable to understand the health outcomes of individuals with frailty. It may be used as an outcome variable for evaluating the impact of interventions either designed to prevent or delay frailty or to assess frailty as an unwanted outcome of interventions such as hospitalization or surgery. A claims-based indicator may also be used as an effect modifier in models of treatment effectiveness where there is expected to be differences in treatment-related response due to frailty. We aim to develop a tool, which we will call the Claims-based Frailty Indicator (CFI) that can be generated with only claims data. This will be developed by translating existing frailty scales into a claims-based tool with appropriate validation. We will explore the value of the CFI by demonstrating heterogeneity of treatment effect and benefit from use of interventions for treatment of aortic stenosis (transcatheter procedures and open surgical procedures). Relevance Frailty is a clinical syndrome characterized by low grip strength, low energy, slowed waking speed, low physical activity, and unintentional weight loss. A tool by which to measure frailty with administrative claims data alone will be highly valuable for exploration of treatment effects in frail individuals when using observational data for research.