Informatics approaches to assessing patient frailty in surgical care

评估外科护理中患者虚弱程度的信息学方法

基本信息

批准号：
10652340
负责人：
Elizabeth Marjorie Cespedes Feliciano
金额：
$ 58.85万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-01 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10652340
关键词：
Abdomen Acute Address Age Aging Algorithms American Biological Caring Chronic Disease Chronology Clinical Code Complex Computer software Consumption Counseling Data Data Set Decision Making Diagnostic Elderly Electronic Health Record Electronics Exhibits Future Goals Hospital Costs Hospital Mortality Hospitals Infiltration Informatics Intervention Laboratories Length of Stay Manuals Measures Methodology Modeling Morbidity - disease rate Muscle Muscular Atrophy National Institute on Aging Operative Surgical Procedures Pathway interactions Patient-Focused Outcomes Patients Performance Perioperative Perioperative Care Physical Function Physiological Population Population Heterogeneity Postoperative Period Predictive Value Process Research Risk Risk Factors Scanning Severity of illness Skeletal Muscle Standardization Surgical complication Technology Time Validation X-Ray Computed Tomography adverse outcome clinical care computer science cost digital electronic data frailty functional status high risk hospital readmission improved innovation inpatient surgery mortality muscle form older patient patient response performance tests postoperative recovery predictive modeling profiles in patients programs prospective risk stratification sarcopenia secondary analysis shared decision making stressor surgery outcome surgical risk tool

项目摘要

ABSTRACT Surgical complications are common, costly, and deadly. Older patients are at high risk of adverse surgical outcomes, especially when they exhibit frailty. Frailty is a state of decreased physiologic reserve and loss of capacity to adapt to stressors. Over the past decade, while frailty has been increasingly recognized as an important risk factor for poor surgical outcomes, integration of a standardized frailty metric into clinical care has not been achieved. A key barrier is that existing frailty assessments are not standardized, objective, or widely available, limiting their routine application in surgical decision-making. With the long-term goal of improving surgical care for older adults, we will evaluate two “e-frailty” metrics that can be automatically derived from electronic or digital data that are already collected as part of routine clinical care. These e-frailty metrics include, first, granular patient profiles of electronic health record (EHR) data (risk scores based on claims data or on physiologic and laboratory values), and second, muscle loss assessed from pre-surgical computed tomography (CT) scans (low skeletal muscle mass, known as sarcopenia, and fatty infiltration into muscle indicative of reduced physical function, known as myosteatosis). In Aim 1, we will calculate these two e-frailty metrics among a diverse population of over 41,000 abdominal surgical patients; characterize the overlap between patients designated as frail by the two e-frailty metrics; and evaluate their associations with 30-day readmission and other adverse surgical outcomes (30-day and 1-year mortality, complications, non-home discharge, and length of stay >7 days). In Aim 2, we will compare the performance of e-frailty metrics for predicting 30-day readmission and other adverse surgical outcomes to that of standard risk stratification tools (acute and chronic illness severity metrics) already embedded in EHRs today using cross-validation and an independent validation dataset of over 14,000 more recent abdominal surgeries. In Aim 3, we will examine whether e-frailty metrics modify the benefits that patients derive from achieving postoperative targets -including early and sustained mobilization- in one of the largest Enhanced Recovery After Surgery (ERAS) programs in the nation. We will examine e-frailty metrics as salient indicators of biologic age for predicting morbidity and mortality. In sum, e-frailty metrics show great promise for identifying high-risk patients in the surgical domain, but they need to be integrated within clinical workflows to be scalable and sustainable. This proposal will compute standardized e-frailty metrics automatically derived from EHR data and provide new information regarding the potential value of these e-frailty metrics for improving surgical care for older adults. This study will also lay the groundwork for future prospective interventions integrating e-frailty metrics into clinical care to improve risk stratification and counseling of patients considering surgery and enhance perioperative care for frail surgical patients.

抽象的手术并发症很常见，费用昂贵且致命。尤其是当他们表现出虚弱时，虚弱是一种生理储备减少和丧失的状态。在过去的十年中，人们越来越认识到虚弱是一种适应压力的能力。手术结果不佳的重要风险因素，将标准化衰弱指标纳入临床护理已尚未实现的一个主要障碍是现有的衰弱评估不够标准化、客观或广泛。可用，限制了它们在手术决策中的常规应用。对于老年人的手术护理，我们将评估两个“电子衰弱”指标，这些指标可以自动导出这些电子衰弱指标已作为常规临床护理的一部分收集。首先，包括电子健康记录 (EHR) 数据的详细患者档案（基于索赔数据的风险评分）或根据生理和实验室值），第二，根据手术前计算得出的肌肉损失评估断层扫描 (CT) 扫描（骨骼肌质量低，称为肌肉减少症，以及脂肪浸润肌肉表明身体功能下降，称为肌脂肪变性）。在目标 1 中，我们将计算这两个 e-frailty。超过 41,000 名腹部手术患者的不同人群的指标描述了重叠的特征；在通过两个电子衰弱指标指定为衰弱的患者之间进行比较，并评估它们与 30 天的关联；再入院和其他不良手术结果（30 天和 1 年死亡率、并发症、非家庭在目标 2 中，我们将比较电子衰弱指标的表现。根据标准风险分层工具预测 30 天再入院和其他不良手术结果（急性和慢性疾病严重程度指标）现已通过交叉验证和在目标 3 中，我们将检查 14,000 多个近期腹部手术的独立验证数据集。电子衰弱指标是否会改变患者从实现术后目标中获得的益处，包括早期和持续的活动——这是美国最大的加速康复外科 (ERAS) 计划之一我们将研究电子衰弱指标作为预测发病率和生物年龄的显着指标。总之，电子衰弱指标在识别外科领域的高危患者方面显示出巨大的前景。但它们需要集成到临床工作流程中才能实现可扩展和可持续。计算从 EHR 数据自动得出的标准化电子衰弱指标并提供新信息关于这些电子衰弱指标对于改善老年人手术护理的潜在价值。还将为未来将电子衰弱指标纳入临床护理的前瞻性干预措施奠定基础改善考虑手术的患者的风险分层和咨询，并加强围手术期护理体弱的手术患者。