Segal JB, Chang HY, Du Y, Walston JD, Carlson MC, Varadhan R. Development of a Claims-based Frailty Indicator Anchored to a Well-established Frailty Phenotype.
Med Care 2017;
55:716-722. [PMID:
28437320 PMCID:
PMC5471130 DOI:
10.1097/mlr.0000000000000729]
[Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND
Fried and colleagues described a frailty phenotype measured in the Cardiovascular Health Study (CHS). This phenotype is manifest when ≥3 of the following are present: low grip strength, low energy, slowed waking speed, low physical activity, or unintentional weight loss. We sought to approximate frailty phenotype using only administrative claims data to enable frailty to be assessed without physical performance measures.
STUDY DESIGN
We used the CHS cohort data linked to participants Medicare claims. The reference standard was the frailty phenotype measured at visits 5 and 9. With penalized logistic regression, we developed a parsimonious index for predicting the frailty phenotype using a linear combination of diagnoses, operationalized with claims data. We assessed the predictive validity of frailty index by examining how well it predicted common aging-related outcomes including hospitalization, disability, and death.
RESULTS
There were 4454 CHS participants from 4 clinical sites. In total, 84% were white, 58% were women and their mean age was 72 years at enrollment. Approximately 11% of the cohort was frail. The model had an area under the receiver operating curve of 0.75 to concurrently predict a frailty phenotype. This Claims-based Frailty Indicator significantly predicted death (odds ratio, 1.84), time to death (hazards ratio, 1.71), number of hospital admissions (incidence rate ratio, 1.74), and nursing home admission (odds ratio, 1.47) in models adjusted for age and sex.
CONCLUSIONS
Claims data alone can be used to classify individuals as frail and nonfrail. The Claims-based Frailty Indicator might be used in research with large datasets for confounding adjustment or risk prediction. The indicator might also be used for emergency preparedness for identification of regions enriched with frail individuals.
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