Excellence in Patient Care Award 2017 – Innovation
The Electronic Frailty Index (eFI) represents a major, innovative advance in the care of older people because, for the first time, it enables identification of frailty using existing primary care data without the need for a resource-intensive clinical assessment.
The eFI Team explain how they improved patient care and give advice on replicating their success.
What were your project’s key outcomes and successes and how has it improved care for patients? Who was involved?
Our project was to develop, validate and implement an electronic frailty index (eFI) that uses routine GP data to enable evidence-based, proactive models of integrated care for older people with frailty.
We followed international guidelines to develop and validate the eFI using routinely collected UK primary care electronic health record (EHR) data from over 900,000 older people in two large primary care databases. The eFI enables the calculation of a frailty score that can be used to identify older people with mild, moderate and severe frailty. A higher eFI score identifies older people at increased risk of care home admission, hospitalisation, and mortality.
Implementation of the eFI into routine primary care practice is a major advance in the care of older people with frailty. The eFI has been implemented in the leading UK primary care EHR systems (SystmOne, EMISWeb, Vision) which means the eFI is now freely available to 99% of GPs across the UK. The eFI is also recommended in the 2016 NICE multimorbidity guideline, and is supported as part of the 2017/18 General Medical Services GP contract.
Our project has been a collaborative partnership between the University of Leeds, TPP/SystmOne, Bradford Teaching Hospitals NHS Foundation Trust, the University of Birmingham, the University of Bradford, the Yorkshire and Humber Academic Health Science Network (AHSN) Improvement Academy, and was funded as part of the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Yorkshire and the Humber (NIHR CLAHRC YH).
How can others replicate your learning and successes? How will the project develop in the future?
A key learning message from our eFI project is that our success was based on the collaborative relationship between academic, NHS and industry partners. In particular, establishment of our strong working relationship with TPP/SystmOne as part of the project enabled the extremely rapid implementation of the eFI into clinical practice following the initial development and validation work.
Our project team has established a frailty collaborative to support the development and evaluation of new models of primary care for people with frailty, and we are now working with 75 CCGs across the country to develop evidence-based proactive care pathways for older people with frailty. Examples include:
- development of integrated community frailty services for older people
- identification of older people with frailty for medication review
- identification of older people with frailty for proactive falls prevent.
How did you overcome any challenges?
There were many academic challenges, including the complexity of the initial eFI development using routine primary care codes and the mapping of the eFI across earlier versions of primary care coding to enable external validation in an independent research dataset. These challenges were overcome through close working between the academic team and our industry partners at TPP/SystmOne, using the ResearchOne primary care database.
Our close academic-NHS-industry partnership meant that we were able to pre-empt additional challenges in terms of wider eFI implementation. For example, we ensured that the eFI was developed using standard primary care codes that would enable implementation across all available primary care electronic health record systems. Prior to the wider eFI rollout, we developed a standard licence agreement that enables eFI implementation into primary care electronic health record systems under agreed terms ensuring that it is made freely available to the NHS at no additional cost.
What does winning the Excellence in Patient Care Award mean for your project and your team? What impact has it had?
Our eFI project team were delighted and honoured to win the RCP Excellence in Patient Care Award, particularly given the outstanding quality of the shortlisted projects. The award has generated considerable additional clinical and academic interest in the eFI, both in the UK and globally. This will help us to continue to drive the development of new care pathways to improve the health and quality of life for older people living with frailty in the UK and internationally.