External validation of the hospital frailty risk score among hospitalised home care clients in Canada: a retrospective cohort study

TitleExternal validation of the hospital frailty risk score among hospitalised home care clients in Canada: a retrospective cohort study
Publication TypeJournal Article
Year of Publication2023
AuthorsTurcotte LAndrew, Heckman G, Rockwood K, Vetrano DLiborio, Hébert P, McIsaac DI, Rhynold E, Mitchell L, Mowbray FImmanuel, Larsen RT, Hirdes JP
JournalAge and Ageing
ISBN Number1468-2834
Accession Number36735847
Keywords*Frailty/diagnosis/epidemiology, *Home Care Services, Aged, Frail Elderly, Frailty, Geriatric Assessment, hospitalisation, Hospitals, Humans, Older adults, Older people, Ontario/epidemiology, Retrospective Studies, Risk Assessment, Risk Factors

The Hospital Frailty Risk Score (HFRS) is scored using ICD-10 diagnostic codes in administrative hospital records. Home care clients in Canada are routinely assessed with Resident Assessment Instrument-Home Care (RAI-HC) which can calculate the Clinical Frailty Scale (CFS) and the Frailty Index (FI).Measure the correlation between the HFRS, CFS and FI and compare prognostic utility for frailty-related outcomes.Retrospective cohort study.Alberta, British Columbia and Ontario, Canada.Home care clients aged 65+ admitted to hospital within 180 days (median 65 days) of a RAI-HC assessment (n = 167,316).Correlation between the HFRS, CFS and FI was measured using the Spearman correlation coefficient. Prognostic utility of each measure was assessed by comparing measures of association, discrimination and calibration for mortality (30 days), prolonged hospital stay (10+ days), unplanned hospital readmission (30 days) and long-term care admission (1 year).The HFRS was weakly correlated with the FI (ρ 0.21) and CFS (ρ 0.28). Unlike the FI and CFS, the HFRS was unable to discriminate for 30-day mortality (area under the receiver operator characteristic curve (AUC) 0.506; confidence interval (CI) 0.502–0.511). It was the only measure that could discriminate for prolonged hospital stay (AUC 0.666; CI 0.661–0.673). The HFRS operated like the FI and CFI when predicting unplanned readmission (AUC 0.530 CI 0.526–0.536) and long-term care admission (AUC 0.600; CI 0.593–0.606).The HFRS identifies a different subset of older adult home care clients as frail than the CFS and FI. It has prognostic utility for several frailty-related outcomes in this population, except short-term mortality.