Comprehensive Geriatric Assessment clinic in primary are: piloting the use of the Electronic Frailty Index

Background: During implementation of a new geriatrician-led Comprehensive Geriatric Assessment (CGA) Clinic in primary care, a profile of the practice's older patients (≥75 years) was required. As multi-morbidity is common in this age group, the search included an extensive list of Read Codes. Consequently, the extraction of data from electronic health records was complex and time consuming. The Electronic Frailty Index (eFI) has the potential to overcome this issue.

Methods: We arranged a pilot of the eFI tool with the participating practice. Staff were shown how to run the Electronic Frailty Index Report for all patients (N = 6,670). As a frailty severity indicator, eFI calculated frailty risk scores from routinely collected primary care data. This included Read Codes appropriate for a profile of older patients.

Results: The data manager ran an eFI report (N = 596) in 5 minutes, demonstrating a substantial reduction in search time to create an older patients’ profile. The frailty index range was 0.03 to 0.61 (mean = 0.22) for all the practice patients aged 75 years and older. Patients referred to the new clinic (n = 15) had a range of 0.19 to 0.53 (mean = 0.32). An additional advantage for the participating practice was that eFI contributed to improved identification of the top 2% of vulnerable patients for Avoiding Unplanned Admissions.

Conclusions: The piloting of the eFI during implementation of the new CGA Clinic in primary care illustrated the practicalities of this tool for clinicians, administrators and researchers. The eFI provided a means of comparing patients referred to the clinic with all the older patients registered at the practice. As eFI is an advisory tool the need for clinical judgement remains essential.