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.

抽象的手术并发症是常见，昂贵且致命的。老年患者患不良手术的高风险结果，尤其是当他们暴露脆弱时。脆弱是生理储备和损失的状态适应压力源的能力。在过去的十年中，虽然脆弱的人越来越被认为是不良手术结果的重要危险因素，将标准化脆弱指标整合到临床护理中的重要危险因素已有没有实现。一个关键的障碍是现有的脆弱评估不是标准化，客观或广泛的可用，限制其在手术决策中的常规应用。具有改进的长期目标对于老年人的手术护理，我们将评估两个可以自动从作为常规临床护理的一部分，已经收集的电子或数字数据。这些电子费用指标首先包括电子健康记录（EHR）数据的颗粒状患者概况（根据索赔数据的风险评分或关于物理和实验室的值），其次，根据手术前计算的肌肉损失断层扫描（CT）扫描（骨骼肌质量低，称为肌肉减少症，脂肪浸润到肌肉中在AIM 1中，我们将计算这两个电子费用超过41,000名腹部手术患者的潜水员人口的指标；表征重叠在两个电子费用指标中指定为脆弱的患者之间；并评估他们的关联30天再入院和其他不良手术结果（30天和1年死亡率，并发症，非家庭出院和住宿时间> 7天）。在AIM 2中，我们将比较E-Frailty指标的性能预测标准风险分层工具的30天再入院和其他不良手术结果（急性和慢性病严重程度指标）今天已经嵌入了EHR中在AIM 3中，我们将检查电子费用指标是否会改变患者从实现术后目标中获得的好处 - 包括早期和持续动员 - 在手术后最大的康复之一（ERA）计划中的动员国家。我们将研究电子限制指标是预测发病率和的生物年龄的显着指标死亡。总而言之，电子费用指标在识别手术领域中的高危患者方面表现出巨大的希望，但是它们需要集成到临床工作流程中，以扩展和可持续。该提议将计算标准化的电子限制指标自动从EHR数据派生并提供新信息关于这些电子费用指标在改善老年人手术护理方面的潜在价值。这项研究还将为将来的前瞻性干预措施奠定基础改善患者的风险分层和咨询考虑手术并提高周期性护理脆弱的手术患者。