Defining frailty within the context of electronic medical records : eCGA mapping to SNOMED CT Brown, Sharde
Background. Frailty is commonly considered an emerging geriatric syndrome that involves a decrease in the physiological ability to respond to stressors, which can lead to increased hospitalization, worsening health, and morbidity. The goals of this work are to: (1) identify frailty within primary health care as early as possible in order to prevent worsening health issues, and (2) explore information collected within electronic medical records that can be better utilized for assessing frailty. Specifically, this work: 1) conducted a literature review to identify what defining characteristics of frailty are captured in the CGA tool; and 2) matched concepts within the Comprehensive Geriatric Assessment (CGA) tool to SNOMED CT, an international standardized terminology. Methods. This research was conducted using a nonexperimental descriptive study design. Manual mapping and expert consensus mapping were used to match concepts from a validated frailty assessment tool the electronic CGA (eCGA) to SNOMED CT; standardized terminologies allow for the sharing and coding of clinical information across different platforms. A literature search was completed to define the relevant characteristics of frailty, and explore the most commonly used assessment tools. These findings were compared with the eCGA to assess content coverage. A visual map supported mapping activities. Results and Conclusion. The literature review showed that the eCGA contained all defining characteristics of frailty. One hundred and thirty-three unique assessment questions were manually mapped to SNOMED CT. Of these, 72% (96/133) were direct matches, 17% (22/133) were one-to-many matches to clinical terms within SNOMED CT, and the remaining 11% (15/133) were non-matches. Two rounds of expert clinician consensus mapping occurred. Inter-rater reliability between the two clinicians was 0.75 (Kappa). The outcome of this study is a list of mapped eCGA elements to SNOMED CT. This list informs a new data table added to a pan-national database for chronic disease monitoring.
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