Validating and Expanding Claims-Based Algorithms of Frailty and Functional Disability for Value-Based Care and Payment

STATUS: Completed Project

BACKGROUND

Patient function, both physical and cognitive, are important outcomes assessed by patient-centered outcomes research (PCOR). Older adults who are frail and people with functional impairment—such as, but not limited to, difficulties with mobility or cognitive impairment that result in limitations in a person’s ability to perform activities of daily living—are at increased risk for poor health outcomes. Frailty increases a person’s risk for functional impairment and cognitive decline. In addition to medical comorbid conditions, identifying frailty and functional disability plays an important role in informing clinical care, risk-adjustment of PCOR studies, and evaluating performance and payments in value-based care programs.  

However, existing algorithms to identify frailty and functional disability have limitations. This project sought to evaluate, improve, and test existing claims-based algorithms of frailty and functional disabilities for potential inclusion in the Chronic Condition Warehouse using Medicare fee-for-service data. Improved data on frail persons with or at risk of functional impairment can help with case identification for research studies and public health surveillance and enable researchers to evaluate clinical and health systems interventions for these vulnerable, high-need patients. 

PURPOSE

• This project aimed to build data capacity to identify frailty to support robust PCOR and use in value-based care and payment by: 
• Developing and validating a claims-based frailty algorithm using Medicare claims, to be made available to the public through the Chronic Condition Warehouse. 
  Evaluating the claims-based frailty algorithm applied to electronic health record (EHR) data and tested in one or more health systems across payers. 
• Compiling an EHR guidance report sharing learnings from the EHR Learning Network and project partners on collecting and extracting information on patients’ frailty and functional status from the EHR. 

KEY IMPACTS:

Providing more relevant, comprehensive data: Development of a claims-based frailty algorithm  
This project developed a new claims-based algorithm to predict two functional impairment outcomes using post-acute care assessment data: memory limitations and activity/mobility limitations. The project reviewed existing claims-based algorithms to predict frailty and functional impairment and compared these to the performance of the new algorithm.

Improving data quality: Evaluation of a claims-based frailty algorithm using EHR data across health systems
The project evaluated the claims-based frailty algorithm using EHR data across health systems with varying degrees of network open/closed-ness. 

Enhancing analytic resources: Implementation guidance for identifying frailty
The project specified use cases on identifying frailty using EHR data in health systems in the U.S. and other countries, which demonstrate applications in both primary and specialist care. The final EHR Implementation Guide summarizes the learnings from the EHR Learning Network and the identified use cases.

PUPLICATIONS

Electronic Frailty Validation. The code used to validate the different frailty algorithms using EHR data is available on GitHub.  
Identifying Frailty Using Existing Health Data: Challenges and Opportunities for Health Systems. This EHR Implementation Guide offers guidance to health systems on using EHR data to identify patients with frailty or functional impairment. It describes the range of ways that EHRs are being used to capture data on frailty and functional impairment and best practices for implementing algorithms using EHR data for population management and patient-centered care.  

Project Summary: Testing & Validation of a Frailty Algorithm with Claims Data and Case Studies on Using EHR Data to Identify Frailty. This document provides a summary of the project, including key findings and identified case studies, as well as links to key resources and project publications and reports.  

Development and Validation of Algorithms to Predict Activity, Mobility, and Memory Limitations Using Medicare Claims and Post-Acute Care Assessments. This article, published in the Journal of Applied Gerontology, describes the development and validation of claims-based algorithms to predict two functional impairment outcomes: any memory limitation and activity/mobility limitations.  

Comparative Performance of Three Claims-Based Frailty Measures Among Medicare Beneficiaries. This article, published in the Journal of Applied Gerontology, describes the results of a comparison of three claims-based algorithms to predict frailty and related concepts. 

ASPE Final Project Report. The final report describes the validation of the existing and project-developed algorithms to predict frailty and functional impairment, including key findings. 

AHRQ Final Project Report. This final report describes the results of a validation of the claims-based frailty index using linked claims-EHR databases of multiple large health systems; an assessment of EHR and claims data regarding the quality of data for frailty analysis; and a comparison of an EHR-based frailty index and the claims-based frailty index