The Pathfields Tool: A frailty case-finding tool using primary care IT—implications for population health management

Abstract

Background: older people living with frailty benefit from targeted interventions which improve health and independence. However, it has been challenging within primary care to systematically identify patients living with frailty. Study aims: 1. To develop and operationalise a frailty case-finding tool (called the Pathfields Tool) in primary care, using primary care IT, that could systematically identify a high-risk population cohort for opportunistic individual validation by a clinician 2. To compare the accuracy of the revised tool with the Electronic Frailty Index (eFI) Methods: primary care IT was re-programmed to create a ‘Pathfields High Risk Cohort’ (PHRC, patients felt likely to have undiagnosed frailty) and invite clinicians to opportunistically assess and diagnose frailty. Results were compared with NHS England’s current approach to frailty identification using Electronic Frailty Index (eFI) to see which approach had the highest diagnostic yield. Results: the Pathfields Tool identified 1,348 patients in PHRC group, of whom 951 (70.5%) were clinically assessed and diagnosed: • 24.1% not frail • 75.9% with frailty (27.3% mild; 29.9% moderate; 18.7% severe) eFI (moderate and severe) identified 683 patients of whom 598 (87.6%) were clinically assessed and diagnosed: • 52.7% not frail • 47.3% with frailty (19.1% mild; 17.19% moderate; 11.2% severe) Extrapolated data would estimate frailty prevalence at 22.5% (1,024/4,552) (5.5% severe, 8.8% moderate, and 8.1% mild) in the practice population aged 65+. Conclusions: the Pathfields Tool identified more patients with clinically confirmed previously undiagnosed frailty than eFI ‘moderate and severe frailty’ alone. Sub-segmenting frailty by residential status could significantly improve the population health management of older people.