Validation of Administrative and Primary Care Electronic Medical Record Derived Frailty Algorithms

BC, AB, MB: Sabrina Wong, Tyler Williamson, Alan Katz

Please describe your research project and how it contributes to improving primary care.

The objective of this work was to:

  1. Use available data to determine a definition of frailty that can be used in electronic medical record (EMR) and administrative data sources;
  2. Examine whether there are differences in demographics or health conditions among those identified as frail in either the EMR or administrative data.

A manuscript about the use of machine learning to create the EMR frailty definition is under review. We found that about one-third (n=302) were identified as frail and 573 (65.5%) were not frail. Key features of frailty included: ICD-9 Code-Dementia (code 290), prescribed medications including: furosemide and vitamins, and the word “obstruction” used within billing notes.

A second manuscript, Challenges Associated with Cross-Jurisdictional Analyses using Administrative Health Data and Primary Care Electronic Medical Records in Canada, was published in the International Journal of Population Data Science in 2018. The purpose of this paper was to compare and contrast the data access procedures in three Canadian jurisdictions (Manitoba, Alberta and BC), and to describe how we addressed the challenges presented by differences in data governance and architecture in a Canadian cross-jurisdictional research study. We characterized common stages in gaining access to administrative data among jurisdictions, including obtaining ethics approval, applying for data access from data custodians, and ensuring the extracted data are released to accredited individuals in secure data environments. We identified advantages of Manitoba’s flexible ‘stewardship’ model over the more restrictive ‘custodianship’ model in BC, and highlight the importance of communication between analysts in each jurisdiction to compensate for differences in coding variables and poor quality data.

What are the key messages from this project to share with stakeholder groups (i.e. clinicians, policy makers, patients)?

This project generated national interest that has resulted in an additional $1M from the Canadian Frailty Network. These funds have allowed for further frailty case validation across multiple provinces (BC, AB, MB, ON, NS) and the creation of an electronic tool to allow primary care clinicians to visualize their patient panel by frailty. This work also enabled the BC-PHCRN to work with the Fraser Health Authority with the purpose of using the BC Canadian Primary Care Sentinel Surveillance Network (BC-CPCSSN) in further case validation in the Fraser Health region. This partnership has also been active in developing educational opportunities for undergraduate nursing students and now has a PhD student completing their dissertation work in the area of frailty.