Use Frailty Status to Predict Postoperative Outcomes in Elderly Patient

虚弱越来越被认为是健康状况不佳的领先指标，甚至死亡，因为 同时也是患者对治疗反应如何的晴雨表。真正做到以患者为中心 护理，提供者应该意识到每个患者的虚弱状态，并将其纳入临床 做决定。提供商现在可以提供许多侵入性和侵略性的程序 心血管疾病，这涉及到风险，可能是痛苦的。治疗强度需要 与预期的患者结果相匹配，但提供者没有可靠的方法来估计 虚弱患者的预后。在这里提出的研究中，我们将使用一种新的方法，即 利用电子健康记录(EHR)识别患者的虚弱状态，目标是 支持回顾性临床研究和前瞻性临床决策。我们的 初步研究已经证明了与脆弱相关的发现在EHR中的可用性， 提取脆性发现的可行性，以及将EHR提取的脆性用于 结果预测。该项目的具体目标是：1)创建脆弱的本体构建 关于现有的功能状态和生活质量测量；2)开发本体论指导， 用于提取脆弱性描述的自然语言处理(NLP)方法 测量；3)开发一个模型来汇总NLP提取的脆弱性发现，以生成 患者水平的脆弱性评分；4)检查全因死亡率和全因再入院 心力衰竭患者在主要心脏手术后一年，有不同的脆弱评分和 评估这些信息对手术决策的影响。

Frailty is increasingly recognized as a leading indicator of poor health outcomes, even death, as well as a barometer of how well patients respond to treatment. To truly provide patient-centered care, providers should be aware of each patient's frailty status and incorporate it into clinical decision making. Providers can now offer a number of invasive and aggressive procedures for cardiovascular disease, which involve risk, and can be painful. The treatment intensity need to match the expected patient outcome, yet providers do not have a reliable method to estimate prognosis for frail patients. In the study proposed here, we will use a novel approach that leverages the electronic health record (EHR) in identifying patient frailty status, with the goal of supporting retrospective clinical studies and prospective clinical decision making. Our preliminary studies have demonstrated the availability of frailty-related findings in EHR, the feasibility of extracting frailty findings, and the feasibility of using EHR-extracted frailty for outcome prediction. The specific aims of the project are to 1) Create a frailty ontology building on existing functional status and quality of life measurements; 2) Develop ontology guided, natural language processing (NLP) methods for extracting frailty descriptions and measurements; 3) Develop a model to aggregate NLP-extracted frailty findings to generate a patient-level frailty score; 4) Examine the all-cause mortality and all-cause hospital readmission one year after major cardiac procedures in heart failure patients with different frailty scores and assess the impact of this information on surgical decision making.