Creating and Validating a Claim-based Indicator of Frailty

描述(由申请人提供)：弗里德描述了一种基于对心血管健康研究中登记的个体队列的观察而得出的虚弱表型。当5个表型标准中的3个，即握力低、能量低、觉醒速度减慢、体力活动少和无意的体重减轻时，这种表型就很明显。后来，她的合作者将虚弱定义为一种医学综合征。我们建议仅使用管理索赔数据来识别脆弱的个人。鉴于索赔数据无处不在，具有良好敏感性和特异性的脆弱性指标将得到广泛使用。通过管理数据确定的脆弱性可以作为暴露变量，以了解脆弱个体的健康结果。它可以作为一个结果变量，用于评估旨在预防或延迟脆弱性的干预措施的影响，或评估脆弱性作为住院或手术等干预措施的不希望看到的结果。基于索赔的指标也可以用作治疗有效性模型中的效果修饰符，在这些模型中，预期由于脆弱而导致与治疗相关的反应存在差异。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化为一个经过适当验证的基于索赔的工具来开发。我们将通过展示治疗效果的异质性和主动脉狭窄介入治疗(经导管手术和开放手术)的益处来探索CFI的价值。相关性虚弱是一种临床综合征，以握力低、能量低、觉醒速度慢、体力活动少和无意体重减轻为特征。在使用观察数据进行研究时，仅通过管理索赔数据来衡量脆弱程度的工具对于探索虚弱个体的治疗效果将具有极高的价值。

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.