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Thandi, Manpreet Kaur Gill

University of British Columbia

Background: Frailty is a state of increased vulnerability from physical, social, and cognitive factors resulting in greater risk of negative health-related outcomes. Primary care settings can help reverse frailty if detected early enough. Yet, there is no standardized tool to screen for frailty in Canadian primary care settings. The purposes of this research were to enhance understanding of the concept of frailty, and to create an electronic frailty index (eFI) using British Columbia (BC) primary care data. Methods: Using a mixed method sequential study design, this research consisted of 3 interrelated sub-studies. In sub-study 1, a modified Delphi using 3 rounds of questionnaires allowed for a panel of 23 experts to review the 36-factor eFI. In sub-study 2, a list of Canadian specific clinical terminologies (ICD9, ICD9-CM, LOINC, ATC, free text) was developed to reflect the 36 frailty factors of the eFI. The data source for the free text search of 527,521 data entries was the BC Canadian Primary Care Sentinel Surveillance Network. In sub-study 3, we developed a frailty algorithm and tested it using a retrospective cross-sectional design. We hypothesized that increasing frailty scores were associated with (1) increased primary care visits, (2) polypharmacy, and (3) cognitive impairment for a sample of 15,178 patients. Results: Sub-study 1 resulted in 92% consensus of the 36 frailty factors. Sub-study 2 resulted in 3,768 clinical terminologies (3,020 clinical codes and 748 free text terms) that reflect the frailty factors. Sub-study 3 resulted in the creation of a frailty algorithm that can calculate frailty scores for patients using EMR data. Regression analyses provided construct validity for the algorithm in demonstrating statistical significance of the associations between frailty and our 3 outcomes. Conclusions: This dissertation resulted in 4 key messages. 1) Frailty needs to be conceptualized as beyond the biomedical in frailty care planning. 2) A combination of standardized codes and free text terms helps capture the complexity of frailty. 3) The eFI could assist with frailty screening in primary care and contribute to EMR optimization. 4) This research supports the implementation of the eFI into BC primary care settings on a pilot basis.

Text

2024-12-23

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/89974

Nursing

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/