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.

项目摘要 Beeson Award旨在为候选人Kathryn E. Callahan博士提供配备，并提供专业知识独立研究者，以提高与衰老相关的指标和干预措施的使用，以促进健康，功能，和脆弱的老年人的生活质量。脆弱的老年人普遍存在，与负面结果，包括住院，流动性残疾，熟练护士设施的录取以及死亡。尽管努力定义和量化脆弱，但时间和资源限制限制了脆弱的可行性临床实践中的措施。 Callahan博士的初步工作支持翻译Anemr-的可行性基于脆弱的指数或EFI - 进入Wake Forest Baptist Health（WFBH）EMR，并展示了初始 EFI得分与住院和死亡率之间的关联。拟议的研究项目代表下一步的关键步骤：（1）要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结果，以及（3）在Medicare共享储蓄中进行实施的飞行员计划/下一代责任心组织初级保健实践，收集关键数据关于可行性，可接受性和有效性。科学目标是开发和实施指数定义一群脆弱的老年人，他们将从个性化的基于证据的干预措施中受益。这项工作对于告知大规模实施试验至关重要，以调解负面和脆弱的老年人的健康状况昂贵。我们假设每年的自我报告和功能数据 EMR中的健康访问（AWV）将进一步完善EFI的预测价值；并实施 EFI将是可行的和可接受的。该项目得到了订婚的导师的支持（威廉姆森博士和 Boustani）和一个高度互动的跨学科咨询委员会（Foley，Rejeski和Pajewski博士）该项目的专业知识和完整技能是值得注意的资产。我们提出适应使用WFBH MSSP/老年人的数据，在WFBH EMR内的EFI进行了细化下一个Gen ACO（AIM 1）：我们将整合AWV数据，并在此中提高EFI分数的预测价值人口。然后，我们将进行一项试点研究，该研究在六个MSSP/下一个ACO中实施了适应的EFI评分初级保健实践，并遵循健康结果。该研究提出与NIA优先级相一致它还将提供必要的培训对于将在实施科学方面建立专业知识的候选人，可以在临床信息方面获得流利性，并发展领先的实施试验的能力。这种方法为您提供了理想的平台促进候选人作为独立调查员的职业，并为建立脆弱的基础提供了基础实践中的指标，利用学习卫生系统实施干预措施以改善健康和功能。