Development, implementation and impact of the electronic Frailty Index (eFI)

Frailty is a condition that is common in old age. It develops because as we get older our bodies change and can lose their inbuilt reserves. These changes mean that older people with frailty can experience sudden dramatic changes in their health when they have an illness. International guidelines recommend frailty should be identified routinely so a more holistic approach to care can be taken, and effective treatments provided.

However, the main historical difficulty with identifying frailty routinely is that available clinical tools, such as measuring walking speed or frailty questionnaires, require additional resource, and might be inaccurate. Researchers from the University of Leeds led the development and national implementation of an electronic frailty index (eFI) that uses routine GP data to identify frailty.

Professor Andrew Clegg and Dr Elizabeth Teale led the underpinning research to develop and validate the eFI in a landmark study funded by the National Institute for Health and Care Research (NIHR). The study used the cumulative deficit model, which identifies frailty on the basis of a range of variables including symptoms, signs, diseases, disabilities and abnormal laboratory values, collectively referred to as deficits. Primary care electronic health record (EHR) systems in the UK use Read Codes to categorise and log multiple patient characteristics including symptoms, signs, laboratory test results, diseases, disabilities and information about social circumstances. Primary care EHR systems therefore provide a potentially simple yet powerful mechanism for identifying cumulative deficits to identify frailty routinely.

Following eFI national implementation, over one million older people in the UK have been assessed for the presence of frailty. Examples of interventions deployed in primary care after identifying people with frailty using the eFI include:

• targeted medication reviews to reduce problematic prescribing
• proactive falls prevention
• supported self-management for people with mild frailty
• comprehensive geriatric assessment as an evidence-based frailty intervention
• advance care planning and palliative care.

The national implementation of the eFI led to major NHS policy impact as it enabled a standardised approach to identifying frailty on a national scale, providing the platform for the 2017/18 NHS England GP contract and inclusion in the 2019 NHS Long Term Plan. Impact on health and care services is supported through inclusion in NICE guidelines and the development of new models of frailty care, cited in national frailty guidelines.

Recognition of impact is through selection as an example of world-class NIHR research making a difference to patient care, and the prestigious 2017 Royal College of Physicians’ (RCP) Excellence in Patient Care Award.

Lead researcher: Andrew Clegg and Elizabeth Teale