UK National Frailty Index

UK National Frailty Index

The ageing population in many countries across the globe poses a considerable challenge to health and social care services. One especially problematic expression of this issue is frailty – older people with frailty are at increased risk of a wide range of adverse health outcomes. There is, however, strong evidence that the frailty state of an older person can be reversed, providing that those most at risk can be identified and supported with early interventions.

Historically, this identification and subsequent early intervention has proved difficult to achieve. However, TPP has engaged in research – in partnership with NHS England, the University of Leeds and the University of Birmingham – which has resulted in the development of the Electronic Frailty Index (eFI). The eFI is an algorithm which assesses the frailty of an elderly person, based only on routinely-collected data from their electronic health record (EHR). Through this algorithm, clinicians can identify those older individuals most at risk of an unplanned hospital admission.

The eFI has now been adopted as part of nationwide guidelines for elderly care management across the NHS. It is built into major EHR systems, and forms part of the NHS outcomes framework for the care of elderly citizens. Moreover, it is helping to deliver new care models for the elderly population which improve patient outcomes and experiences. It also serves to increase financial sustainability on a national level through its focus on prevention, thus reducing the higher costs associated with acute care.

The eFI was developed using comprehensive, anonymised data collected from two primary care databases, comprised of the EHRs of over 900,000 older patients. It enabled the calculation of a frailty score, and became available as an innovative function within TPP’s SystmOne platform. This score can be used to identify people with mild, moderate or severe frailty, and a higher eFI score identifies those at increased risk of care home admission, hospitalisation, and mortality. From July 2017 onwards, the NHS-specified GP contract included the identification and management of patients with frailty. It specifies that a tool such as the eFI should be used to identify patients aged 65 and over who are living with moderate or severe frailty. Where required, this will allow practices to undertake clinical reviews of patients with severe frailty, and carry out early clinical interventions for those individuals in this cohort.

The key benefit of the eFI is that it uses conventional GP data to create proactive models of integrated care for older people with frailty. The Royal College of Physicians (RCP) have commented on the “major, innovative advance” the eFI has provided in elderly care, primarily due to its use of pre-existing primary care data. The eFI has allowed for the development of community frailty services for older people, as well as the identification of those with frailty for the purposes of medication reviews and prevention of falls.

The eFI is an award winning algorithm, having won the innovation category at the RCP’s 2017 Excellence in Patient Care awards. The platform is available to the NHS at no extra cost, and the algorithm’s use of standard primary care codes allows for seamless implementation into existing EHR systems. These measures have achieved widespread eFI coverage – the algorithm is now available to 99% of GPs across the UK. However, the eFI has been developed using coding systems that are widely available in other countries, meaning that the index is by no means limited to the UK.

The implementation of the eFI into regular primary care constitutes a significant step forward in the care of older people with frailty. It will result in improved patient outcomes, better patient experiences and increased financial sustainability. It allows for early intervention, prioritising prevention and identifying risk. The algorithm’s use of standard coding systems means that these improvements are highly replicable, on both a national and international level.