Home visits: A new screening tool for frailty? A retrospective exploratory study.
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Background: In the United Kingdom, the new NHS contract for primary care mandates that practices use the Electronic Frailty Index (EFI) to screen for frailty and apply clinical judgment, based on knowledge of the patient, to decide whether they have a diagnosis of frailty. EFI has not yet been validated for this purpose. Many primary care clinicians would agree that although not formally investigated, there seems to be a strong association between being housebound or in institutional care and having a diagnosis of frailty. Although being housebound or in institutional care is not commonly coded in primary care computer record systems (IT), this cohort of patients do require home visits if they become unwell. Home visits are coded and it is simple to run a search on primary care IT to generate a list of older people who have received a home over given period. Aim: This study assessed whether being housebound and requiring home visits could form a new screening tool for frailty. Design and Setting: Retrospective cohort study from 1/3/15 to 29/2/16. Primary care, South Devon. Method: Medical records of 154 patients over 65 years of age were evaluated. Patients were divided into two groups: a group (n = 82) that had received a home visit and a second group consisting of a randomized sample of patients (n = 72) with similar baseline characteristics who had not. Patient records were analyzed by two clinicians to determine whether a frailty syndrome was present. Researchers were blinded to each other's results. An arbitrator determined the frailty status on disagreement. Results: Home visits have a sensitivity of 87.23% [95% confidence interval (CI): 74.35%-95.17%] and specificity of 61.68% (95% CI: 51.78%-70.92%). For frailty, Cohen's Kappa showed fair interobserver reliability. Conclusion: This study suggests that home visits are a good screen for frailty; the data are easy to retrieve from primary care IT and could be used as a valid screening tool to assist with identifying frailty in primary care.
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