Predictive validity of a two-step tool to map frailty in primary care

BMC Medicine

René J. F. Melis²  Marcel G. M. Olde Rikkert³  Ian Philp⁴  Henk J. Schers¹  Janneke A. L. van Kempen² 

[1] Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, 6500 HB, The Netherlands;Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, 6500 HB, The Netherlands;Department of Geriatric Medicine, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, 6500 HB, The Netherlands;Heart of England NHS Trust, Netherwood House, Solihull Hospital, Lode Lane, Solihull B91 2LJ, UK

关键词: Predictive value;    Available information;    General practice;    Primary health care;    Frailty assessment;   

Others  :  1234647
DOI  :  10.1186/s12916-015-0519-9

 received in 2015-07-28, accepted in 2015-11-03,  发布年份 2015

【 摘 要 】

Background

EASY-Care Two step Older people Screening (EASY-Care TOS) is a stepped approach to identify frail older people at risk for negative health outcomes in primary care, and makes use of General Practitioners’ (GPs) readily-available information. We aimed to determine the predictive value of EASY-Care TOS for negative health outcomes within the year from assessment.

Methods

A total of 587 patients of four GP practices in and around Nijmegen (The Netherlands) consented to participate in a longitudinal primary care registry based cohort study. Participants’ frailty was judged by their GP following the EASY-Care TOS procedure and by a Comprehensive Geriatric Assessment (CGA) at baseline. After one year health outcomes of the participants were measured by reassessment with the EASY-Care TOS procedure.

Results

Follow up information was available for 520 of 587 participants. In the non-frail group 9 % showed any negative health outcomes (death, ADL decline, institutionalisation, too ill to undergo assessment), against 30 % in the frail group (95 % confidence interval of the difference (CI): 14 %–28 %). Area under the receiver operating curve (AUC) of the EASY-Care TOS frailty judgement for a composite of negative health outcomes mentioned was 0.67 (95 % CI: 0.62-0.73). Compared with discrimination on the basis of age, sex and GP practice (AUC 0.70), adding EASY-Care TOS frailty judgement increased the AUC to 0.75 (+0.05, p = 0.02). The AUC on the basis of a full CGA is almost comparable to the AUC of the model with age, sex, and frailty judgement with EASY-Care TOS: 0.76 (+0.07, p = 0.005).

Conclusions

GPs applying the EASY-Care TOS procedure, where they only perform additional assessment when they judge this as necessary, can predict negative health outcomes in their older populations efficiently and almost as accurately as a complete specialist CGA.

【 授权许可】

   
2015 van Kempen et al.

【 图 表 】

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【 参考文献 】

• [1]Kodner DL. The quest for integrated systems of care for frail older persons. Aging Clin Exp Res. 2002; 14(4):307-13.
• [2]Erler A, Bodenheimer T, Baker R, Goodwin N, Spreeuwenberg C, Vrijhoef HJ et al.. Preparing primary care for the future - perspectives from the Netherlands, England, and USA. Z Evid Fortbild Qual Gesundhwes. 2011; 105(8):571-80.
• [3]Wilhelmson K, Duner A, Eklund K, Gosman-Hedstrom G, Blomberg S, Hasson H et al.. Design of a randomized controlled study of a multi-professional and multidimensional intervention targeting frail elderly people. BMC Geriatr. 2011; 11:24. BioMed Central Full Text
• [4]Boeckxstaens P, De Graaf P. Primary care and care for older persons: position paper of the European Forum for Primary Care. Qual Prim Care. 2011; 19(6):369-89.
• [5]Stuck AE, Iliffe S. Comprehensive geriatric assessment for older adults. BMJ. 2011; 343:d6799.
• [6]Ellis G, Whitehead MA, Robinson D, O’Neill D, Langhorne P. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ. 2011; 343:d6553.
• [7]Cohen HJ, Feussner JR, Weinberger M, Carnes M, Hamdy RC, Hsieh F et al.. A controlled trial of inpatient and outpatient geriatric evaluation and management. N Engl J Med. 2002; 346(12):905-12.
• [8]Fletcher AE, Price GM, Ng ES, Stirling SL, Bulpitt CJ, Breeze E et al.. Population-based multidimensional assessment of older people in UK general practice: a cluster-randomised factorial trial. Lancet. 2004; 364(9446):1667-77.
• [9]Monteserin R, Brotons C, Moral I, Altimir S, San Jose A, Santaeugenia S et al.. Effectiveness of a geriatric intervention in primary care: a randomized clinical trial. Fam Pract. 2010; 27(3):239-45.
• [10]Pialoux T, Goyard J, Lesourd B. Screening tools for frailty in primary health care: a systematic review. Geriatr Gerontol Int. 2012; 12(2):189-97.
• [11]De Lepeleire J, Iliffe S, Mann E, Degryse JM. Frailty: an emerging concept for general practice. Br J Gen Pract. 2009; 59(562):e177-82.
• [12]Daniels R, van Rossum E, Beurskens A, van den Heuvel W, de Witte L. The predictive validity of three self-report screening instruments for identifying frail older people in the community. BMC Public Health. 2012; 12:69. BioMed Central Full Text
• [13]van Kempen JA, Schers HJ, Jacobs A, Zuidema SU, Ruikes F, Robben SH et al.. Development of an instrument for the identification of frail older people as a target population for integrated care. Br J Gen Pract. 2013; 63(608):e225-31.
• [14]Melis RJ, van Eijken MI, Teerenstra S, van Achterberg T, Parker SG, Borm GF et al.. A randomized study of a multidisciplinary program to intervene on geriatric syndromes in vulnerable older people who live at home (Dutch EASYcare Study). J Gerontol A Biol Sci Med Sci. 2008; 63(3):283-90.
• [15]Gobbens RJ, van Assen MA, Luijkx KG, Wijnen-Sponselee MT, Schols JM. The Tilburg Frailty Indicator: psychometric properties. J Am Med Dir Assoc. 2010; 11(5):344-55.
• [16]Suijker JJ, Buurman BM, van Rijn M, van Dalen MT, ter Riet G, van Geloven N et al.. A simple validated questionnaire predicted functional decline in community-dwelling older persons: prospective cohort studies. J Clin Epidemiol. 2014; 67(10):1121-30.
• [17]Raiche M, Hebert R, Dubois MF. PRISMA-7: a case-finding tool to identify older adults with moderate to severe disabilities. Arch Gerontol Geriatr. 2008; 47(1):9-18.
• [18]Drubbel I, de Wit NJ, Bleijenberg N, Eijkemans RJ, Schuurmans MJ, Numans ME. Prediction of adverse health outcomes in older people using a frailty index based on routine primary care data. J Gerontol A Biol Sci Med Sci. 2013; 68(3):301-8.
• [19]van Kempen JA, Schers HJ, Melis RJ, Olde Rikkert MG. Construct validity and reliability of a two-step tool for the identification of frail older people in primary care. J Clin Epidemiol. 2014; 67(2):176-83.
• [20]Keiren SM, van Kempen JA, Schers HJ, Rikkert MG, Perry M, Melis RJ. Feasibility evaluation of a stepped procedure to identify community-dwelling frail older people in general practice. A mixed methods study. Eur J Gen Pract. 2014; 20(2):107-13.
• [21]van Kempen JA, Melis RJ, Perry M, Schers HJ, Rikkert MG. Diagnosis of frailty after a Comprehensive Geriatric Assessment: differences between family phyisicans and geriatricians. J Am Board Fam Med. 2015; 28(2):240-8.
• [22]Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963; 185:914-9.
• [23]Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM. The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol. 2003; 56(11):1129-35.
• [24]El Khouli RH, Macura KJ, Barker PB, Habba MR, Jacobs MA, Bluemke DA. Relationship of temporal resolution to diagnostic performance for dynamic contrast enhanced MRI of the breast. J Magn Reson Imag. 2009; 30(5):999-1004.
• [25]Woo J, Leung J, Morley JE. Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation. J Am Geriatr Soc. 2012; 60(8):1478-86.
• [26]Hoogerduijn JG, Buurman BM, Korevaar JC, Grobbee DE, de Rooij SE, Schuurmans MJ. The prediction of functional decline in older hospitalised patients. Age Ageing. 2012; 41(3):381-7.
• [27]Pijpers E, Ferreira I, Stehouwer CD, Nieuwenhuijzen Kruseman AC. The frailty dilemma. Review of the predictive accuracy of major frailty scores. Eur J Intern Med. 2012; 23(2):118-23.
• [28]De Saint-Hubert M, Schoevaerdts D, Cornette P, D’Hoore W, Boland B, Swine C. Predicting functional adverse outcomes in hospitalized older patients: a systematic review of screening tools. J Nutr Health Aging. 2010; 14(5):394-9.
• [29]Sourial N, Bergman H, Karunananthan S, Wolfson C, Payette H, Gutierrez-Robledo LM et al.. Implementing frailty into clinical practice: a cautionary tale. J Gerontol A Biol Sci Med Sci. 2013; 68(12):1505-11.
• [30]Drewes YM, Blom JW, Assendelft WJ, Stijnen T, den Elzen WP, Gussekloo J. Variability in vulnerability assessment of older people by individual general practitioners: a cross-sectional study. PLoS One. 2014; 9(11):e108666.
• [31]Weinberger M, Samsa GP, Schmader K, Greenberg SM, Carr DB, Wildman DS. Comparing proxy and patients’ perceptions of patients’ functional status: results from an outpatient geriatric clinic. J Am Geriatr Soc. 1992; 40(6):585-8.
• [32]Brooke P, Bullock R. Validation of a 6 item cognitive impairment test with a view to primary care usage. Int J Geriatr Psychiatry. 1999; 14(11):936-40.
• [33]van der Zee K, Sanderman R. Het meten van de algemene gezondheidstoestand met de rand-36, een handleiding. 2002.
• [34]Lutomski JE, Baars MA, Schalk BW, Boter H, Buurman BM, den Elzen WP, Jansen AP, Kempen GI, Steunenberg B, Steyerberg EW et al.. The development of the Older Persons and Informal Caregivers Survey Minimum DataSet (TOPICS-MDS): a large-scale data sharing initiative. PLoS One. 2013; 8(12):e81673.