External validation of the hospital frailty risk score among hospitalised home care clients in Canada: a retrospective cohort study

Luke Andrew Turcotte, George Heckman, Kenneth Rockwood, Davide Liborio Vetrano, Paul Hébert, Daniel I. McIsaac, Elizabeth Rhynold, Lori Mitchell, Fabrice Immanuel Mowbray, Rasmus T. Larsen, John P. Hirdes

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Résumé

BACKGROUND: The Hospital Frailty Risk Score (HFRS) is scored using ICD-10 diagnostic codes in administrative hospital records. Home care clients in Canada are routinely assessed with Resident Assessment Instrument-Home Care (RAI-HC) which can calculate the Clinical Frailty Scale (CFS) and the Frailty Index (FI). OBJECTIVE: Measure the correlation between the HFRS, CFS and FI and compare prognostic utility for frailty-related outcomes. DESIGN: Retrospective cohort study. SETTING: Alberta, British Columbia and Ontario, Canada. SUBJECTS: Home care clients aged 65+ admitted to hospital within 180 days (median 65 days) of a RAI-HC assessment (n = 167,316). METHODS: Correlation between the HFRS, CFS and FI was measured using the Spearman correlation coefficient. Prognostic utility of each measure was assessed by comparing measures of association, discrimination and calibration for mortality (30 days), prolonged hospital stay (10+ days), unplanned hospital readmission (30 days) and long-term care admission (1 year). RESULTS: The HFRS was weakly correlated with the FI (ρ 0.21) and CFS (ρ 0.28). Unlike the FI and CFS, the HFRS was unable to discriminate for 30-day mortality (area under the receiver operator characteristic curve (AUC) 0.506; confidence interval (CI) 0.502-0.511). It was the only measure that could discriminate for prolonged hospital stay (AUC 0.666; CI 0.661-0.673). The HFRS operated like the FI and CFI when predicting unplanned readmission (AUC 0.530 CI 0.526-0.536) and long-term care admission (AUC 0.600; CI 0.593-0.606). CONCLUSIONS: The HFRS identifies a different subset of older adult home care clients as frail than the CFS and FI. It has prognostic utility for several frailty-related outcomes in this population, except short-term mortality.

Langue d'origineEnglish
JournalAge and Ageing
Volume52
Numéro de publication2
DOI
Statut de publicationPublished - févr. 1 2023

Note bibliographique

Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

ASJC Scopus Subject Areas

  • Ageing
  • Geriatrics and Gerontology

PubMed: MeSH publication types

  • Journal Article

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