eFI: electronic Frailty Index

Yorkshire & Humber Academic Health Science Network’s Healthy Ageing programme is a coordinated programme of evidence-based improvement interventions focusing on supporting primary care teams and frontline care home staff to keep people well for longer. We have developed, validated and implemented an electronic Frailty Index (eFI) that uses routine GP data to enable evidence-based, proactive models of integrated care for older people with frailty. The electronic Frailty Index (eFI) has been developed as a collaborative partnership between the University of Leeds, TPP (a UK company who provide the SystmOne primary care electronic health record used by one third of the UKs General Practitioners), Bradford Teaching Hospitals NHS Foundation Trust, Bradford University and Birmingham University. We followed international guidelines to develop and validate the eFI using routinely collected UK primary care electronic health record (EHR) data from over 900,000 older people in two large primary care databases. The eFI comprises of 36 ‘deficits’ (clinical signs, symptoms, diseases and disabilities), which are constructed using around 2,000 routinely available codes related to a patient’s diagnosis. The eFI enables the automatic calculation of a frailty score that can be used to identify older people with mild, moderate and severe frailty, without the need for a resource-intensive clinical assessment. A higher eFI score identifies older people at increased risk of care home admission, hospitalisation, and mortality (Clegg Age Ageing 2016). The eFI has been implemented in the leading UK primary care EHR systems which means it is available to GPs across the UK. Importantly, the eFI has been developed using coding systems that are widely available in other countries, enabling future international implementation Implementation of the eFI into routine primary care practice is a major advance in the care of older people with frailty. A frailty collaborative has been developed as part of the Yorkshire & Humber Academic Health Science Network Improvement Academy (http://www.improvementacademy.org/improving-quality/healthy-ageing.html), which is supporting the development and evaluation of new models of primary care for people with frailty. The eFI is being used by GPs and CCGs across the country to develop better, more proactive care pathways for older people with frailty. Examples include:
• Development of integrated community frailty services for older people,
• Identification of older people with frailty for medication reviews,
• Identification of older people with frailty for proactive falls prevention.