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

项目摘要 比森奖旨在让候选人凯瑟琳·E·卡拉汉博士具备成为一名 独立调查员推动使用与老龄化有关的指标和干预措施，以促进健康、功能 以及虚弱和高危老年人的生活质量。虚弱在老年人中很普遍，并与 负面结果，包括住院、行动不便、进入熟练护理设施以及 死亡率。尽管人们努力定义和量化脆弱性，但时间和资源的限制限制了脆弱性的可行性。 临床实践中的措施。卡拉汉博士的初步工作支持翻译电子病历的可行性- 基于脆弱指数，或EFI-进入Wake Forest Baptist Health(WFBH)EMR，并演示了初始 EFI评分与住院和死亡率之间的关系。拟议的研究项目代表了 关键的下一步：(1)使用门诊护理数据调整和完善EFI，(2)评估其预测价值 老年人的医疗保健结果，以及(3)在联邦医疗保险共享储蓄中进行实施试点 计划/下一代责任关怀组织初级保健实践，以收集关键数据 关于可行性、可接受性和有效性。科学的目标是开发和实施一个索引 确定将从个性化的循证干预中受益的虚弱老年人群体。 这项工作对于为更大规模的干预实施试验提供信息至关重要，以调解负面和 对虚弱的老年人造成昂贵的健康后果。我们假设年度报告中的自我报告和功能数据 EMR中的健康状况访问(AWV)将进一步完善EFI的预测价值； EFI将是可行和可接受的。该项目得到了敬业导师(威廉姆森博士和 (布斯塔尼)和一个高度互动的跨学科咨询委员会(Foley、Rejeski和Pajesski博士) 他们的专长和互补技能是这个项目的一项值得注意的资产。我们建议作出适应化修改 以及WFBH EMR中EFI的精细化，使用登记在WFBH MSSP/中的老年人的数据 下一代ACO(目标1)：我们将整合AWV数据，并在此提炼EFI分数的预测值 人口。然后，我们将在六个MSSP/下一代ACO中进行实施调整后的EFI分数的试点研究 初级保健做法，并遵循健康结果。建议的研究与NIA的优先事项一致 随着年龄的增长，提高成年人的健康、幸福感和独立性。它还将提供基本的培训 对于候选人来说，他将在实施科学方面建立专业知识，在临床信息学方面取得流利的成绩， 并培养领导实施试验的能力。此方法提供了理想的平台 促进候选人作为独立调查员的职业生涯，并为建立脆弱性提供基础 实践中的指标，利用学习卫生系统实施干预措施，以改善健康和 功能。

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.