R01AG071809

Applications of Claims-Based Frailty Index to Advance Evidence for Frailty-Guided Decision-Making - Project Summary/Abstract

Older adults with frailty are more likely to experience poor health outcomes after acute illnesses, drug-related adverse events, and surgeries. Health care costs for frail patients double due to acute hospital care, post-acute care, and treatments for preventable conditions. Despite the clinical and societal consequences of frailty, frailty is rarely assessed in clinical practice, and little evidence exists on how to integrate frailty to inform clinical care and population health management.

The critical step to generate this evidence is to measure frailty on a large scale with high accuracy and efficiency. To address this need, the investigator team recently developed and validated a claims-based frailty index (CFI), which enables measurement of frailty from Medicare data for large populations when in-person assessment is not feasible.

The objective of this application is to generate evidence needed for frailty-guided clinical care and population health management by applying CFI to claims data-based studies of drug therapy; pragmatic clinical trials of procedural therapy; and electronic health records (EHR)-Medicare linked data of a health care system. The central hypothesis is that frailty information will improve care of older adults by uncovering meaningful variations in the treatment benefit-harm profile, costs, and resource needs.

To test this hypothesis, the investigator team with extensive expertise in frailty, pharmacoepidemiologic methods, and health services research will accomplish the following specific aims in the next 5 years:

1) Determine how frailty changes the benefits and harms of 10 prescription drugs for chronic conditions in older adults by applying CFI to the 2014-2022 5% Medicare random sample;

2) Determine how frailty changes the benefits and harms of procedural therapies in older adults by applying CFI to Medicare data linked to 2 ongoing pragmatic clinical trials of endovascular vs surgical revascularization therapy for peripheral arterial disease and acupuncture vs usual care for chronic low back pain; and

3) Determine whether implementing CFI to EHR-Medicare linked data can predict high-cost and high-need patients in a large health care system in Boston, Massachusetts.

The innovative applications of CFI are readily scalable to claims-based comparative effectiveness and safety studies, clinical trials, and EHR in health care systems. The impact of this research is significant because the clinically actionable evidence generated from this research can enable optimal choice of drug and procedural therapy and a health system-wide risk stratification based on frailty. Ultimately, these results will accelerate integration of frailty in routine care and facilitate frailty-guided clinical care and population health management.

Hebrew Rehabilitation Center

TO ENCOURAGE BIOMEDICAL, SOCIAL, AND BEHAVIORAL RESEARCH AND RESEARCH TRAINING DIRECTED TOWARD GREATER UNDERSTANDING OF THE AGING PROCESS AND THE DISEASES, SPECIAL PROBLEMS, AND NEEDS OF PEOPLE AS THEY AGE. THE NATIONAL INSTITUTE ON AGING HAS ESTABLISHED PROGRAMS TO PURSUE THESE GOALS. THE DIVISION OF AGING BIOLOGY EMPHASIZES UNDERSTANDING THE BASIC BIOLOGICAL PROCESSES OF AGING. THE DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY SUPPORTS RESEARCH TO IMPROVE THE ABILITIES OF HEALTH CARE PRACTITIONERS TO RESPOND TO THE DISEASES AND OTHER CLINICAL PROBLEMS OF OLDER PEOPLE. THE DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH SUPPORTS RESEARCH THAT WILL LEAD TO GREATER UNDERSTANDING OF THE SOCIAL, CULTURAL, ECONOMIC AND PSYCHOLOGICAL FACTORS THAT AFFECT BOTH THE PROCESS OF GROWING OLD AND THE PLACE OF OLDER PEOPLE IN SOCIETY. THE DIVISION OF NEUROSCIENCE FOSTERS RESEARCH CONCERNED WITH THE AGE-RELATED CHANGES IN THE NERVOUS SYSTEM AS WELL AS THE RELATED SENSORY, PERCEPTUAL, AND COGNITIVE PROCESSES ASSOCIATED WITH AGING AND HAS A SPECIAL EMPHASIS ON ALZHEIMER'S DISEASE. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO EXPAND AND IMPROVE THE SBIR PROGRAM, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION.

93.866 - Aging Research

National Institute on Aging (NIA) [HHS - NIH]

Roslindale, Massachusetts 021311000 United States

Single Zip Code

NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed) (PA-20-185)

Amendment Since initial award the total obligations have increased 436% from $651,867 to $3,494,224.