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Predictive validity of a two-step tool to map frailty in primary care
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van Kempen, Janneke A. L., Schers, Henk J., Philp, Ian, Olde Rikkert, Marcel G. M. and Melis, René J. F. (2015) Predictive validity of a two-step tool to map frailty in primary care. BMC Medicine, 13 (1). doi:10.1186/s12916-015-0519-9 ISSN 1741-7015.
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Official URL: http://dx.doi.org/10.1186/s12916-015-0519-9
Abstract
Background
EASY-Care Two step Older people Screening (EASY-Care TOS) is a stepped approach to identify frail older people at risk for negative health outcomes in primary care, and makes use of General Practitioners’ (GPs) readily-available information. We aimed to determine the predictive value of EASY-Care TOS for negative health outcomes within the year from assessment.
Methods
A total of 587 patients of four GP practices in and around Nijmegen (The Netherlands) consented to participate in a longitudinal primary care registry based cohort study. Participants’ frailty was judged by their GP following the EASY-Care TOS procedure and by a Comprehensive Geriatric Assessment (CGA) at baseline. After one year health outcomes of the participants were measured by reassessment with the EASY-Care TOS procedure.
Results
Follow up information was available for 520 of 587 participants. In the non-frail group 9 % showed any negative health outcomes (death, ADL decline, institutionalisation, too ill to undergo assessment), against 30 % in the frail group (95 % confidence interval of the difference (CI): 14 %–28 %). Area under the receiver operating curve (AUC) of the EASY-Care TOS frailty judgement for a composite of negative health outcomes mentioned was 0.67 (95 % CI: 0.62-0.73). Compared with discrimination on the basis of age, sex and GP practice (AUC 0.70), adding EASY-Care TOS frailty judgement increased the AUC to 0.75 (+0.05, p = 0.02). The AUC on the basis of a full CGA is almost comparable to the AUC of the model with age, sex, and frailty judgement with EASY-Care TOS: 0.76 (+0.07, p = 0.005).
Conclusions
GPs applying the EASY-Care TOS procedure, where they only perform additional assessment when they judge this as necessary, can predict negative health outcomes in their older populations efficiently and almost as accurately as a complete specialist CGA.
Item Type: | Journal Article | ||||||||
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Subjects: | R Medicine > R Medicine (General) | ||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Social Sciences > Warwick Business School Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Primary care (Medicine), Frail elderly | ||||||||
Journal or Publication Title: | BMC Medicine | ||||||||
Publisher: | BioMed Central Ltd. | ||||||||
ISSN: | 1741-7015 | ||||||||
Official Date: | 3 December 2015 | ||||||||
Dates: |
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Volume: | 13 | ||||||||
Number: | 1 | ||||||||
DOI: | 10.1186/s12916-015-0519-9 | ||||||||
Status: | Peer Reviewed | ||||||||
Publication Status: | Published | ||||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||||
Funder: | Nederlandse Organisatie voor Wetenschappelijk Onderzoek. Medische Wetenschappen (ZonMw) | ||||||||
Grant number: | 60-61900-98-217(ZonMw); |
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