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

识别初级保健中的衰弱：实施基于电子病历的衰弱指数

基本信息

批准号：
9769615
负责人：
Kathryn Callahan
金额：
$ 23.82万
依托单位：
WAKE FOREST UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9769615
关键词：
Academic Medical Centers Address Admission activity Adoption Adult Advisory Committees Age Aging Ambulatory Care Attitude Award Baptist Church British Capsicum Caring Cessation of life Classification Clinical Clinical Informatics Clinical Medicine Competence Computerized Medical Record Congestive Heart Failure Data Decision Making Development Plans Educational Intervention Effectiveness Elderly Enrollment Environment Evidence based intervention Foundations Frail Elderly Future Geriatrics Goals Guidelines Health Health Care Costs Health Promotion Health system Healthcare Healthcare Systems Hospitalization Institutes Intervention Intervention Studies Intervention Trial Knowledge Learning Measures Mediating Medical Medicare Mentors Modeling National Health Services Outcome Patient Self-Report Patients Personal Satisfaction Physical Function Pilot Projects Population Predictive Value Primary Health Care Prognostic Marker Provider Quality of life Randomized Readiness Research Research Personnel Research Project Grants Resources Risk Savings Site Skilled Nursing Facilities Social Functioning Social support Societies System Testing Time Training Translating Translational Research United Kingdom Visit Work base care costs care outcomes care providers career career development clinical implementation clinical practice cognitive function disability experience fall risk falls forest frailty hospital readmission implementation science implementation trial improved indexing innovation interest medical schools mortality next generation programs response skills treatment as usual

项目摘要

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.

项目概要该 Beeson 奖旨在为候选人 Kathryn E. Callahan 博士提供成为一名独立调查员推进使用与衰老相关的指标和干预措施来促进健康、功能、虚弱和高危老年人的生活质量虚弱在老年人中普遍存在，并且与虚弱和高危老年人的生活质量有关。负面结果，包括住院、行动不便、入住专业护理机构，以及尽管努力定义和量化衰弱，但时间和资源限制限制了衰弱的可行性。 Callahan 博士的初步工作支持了翻译 EMR- 的可行性。基于虚弱指数 (eFI) – 进入维克森林浸信会健康 (WFBH) EMR，并展示了初始拟议的研究项目代表了 eFI 评分与住院率和死亡率之间的关联。接下来的关键步骤：(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成果，以及 (3) 在医疗保险共享储蓄中进行试点实施计划/下一代责任医疗组织初级保健实践，收集关键数据关于可行性、可接受性和有效性的科学目标是制定和实施一个指数。定义可以从个性化循证干预措施中受益的体弱老年人群体。这项工作对于为更大规模的干预措施实施试验提供信息至关重要，以调解消极和我们勇敢地面对年度报告中的自我报告和功能数据。 EMR 中的健康就诊 (AWV) 将进一步完善 eFI 的预测价值以及实施情况； eFI 将是可行且可接受的。该项目得到了参与的导师（Williamson 博士和 Drs. Williamson）的支持。 Boustani）和高度互动的跨学科咨询委员会（Foley、Rejeski 和 Pajewski 博士）他们的专业知识和互补技能是该项目的重要资产。使用参加 WFBH MSSP 的老年人的数据，完善 WFBH EMR 中的 eFI/ 下一代 ACO（目标 1）：我们将整合 AWV 数据，并在此过程中完善 eFI 分数的预测价值然后，我们将在六个 MSSP/下一代 ACO 中实施调整后的 eFI 评分的试点研究。拟议的研究与 NIA 的优先事项一致。随着年龄的增长，它还将改善成年人的健康、福祉和独立性。对于候选人来说，他们将建立实施科学方面的专业知识，熟练掌握临床信息学，并培养领导实施试验的能力。这种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，并为建立脆弱性奠定基础实践中的指标，利用学习健康系统实施干预措施，以改善健康和功能。