Clinical Utility of the Risk Analysis Index as a Prospective Frailty Screening Tool within a Multi-practice, Multi-hospital Integrated Healthcare System.

Autor:	Varley PR; Department of Surgery, University of Pittsburgh, Pittsburgh, PA., Borrebach JD; Wolff Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA., Arya S; Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA; Surgical Service Line VA Palo Alto Healthcare System, Palo Alto, CA., Massarweh NN; Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey VA Medical Center, Houston, TX; Division of Surgical Oncology, Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX., Bilderback AL; Wolff Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA., Wisniewski MK; Wolff Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA., Nelson JB; Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA., Johnson JT; Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA., Johanning JM; Department of Surgery, University of Nebraska Medical Center, Omaha, NE; Nebraska Western Iowa VA Health System, Omaha, NE., Hall DE; Department of Surgery, University of Pittsburgh, Pittsburgh, PA.; Wolff Center at UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA.; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2021 Dec 01; Vol. 274 (6), pp. e1230-e1237.
DOI:	10.1097/SLA.0000000000003808
Abstrakt:	Objective: The goal of this project was to first address barriers to implementation of the Risk Analysis Index (RAI) within a large, multi-hospital, integrated healthcare delivery system, and to subsequently demonstrate its utility for identifying at-risk surgical patients. Background: Prior studies demonstrate the validity of the RAI for evaluating preoperative frailty, but they have not demonstrated the feasibility of its implementation within routine clinical practice. Methods: Implementation of the RAI as a frailty screening instrument began as a quality improvement initiative at the University of Pittsburgh Medical Center in July 2016. RAI scores were collected within a REDCap survey instrument integrated into the outpatient electronic health record and then linked to information from additional clinical datasets. NSQIP-eligible procedures were queried within 90 days following the RAI, and the association between RAI and postoperative mortality was evaluated using logistic regression and Cox proportional hazards models. Secondary outcomes such as inpatient length of stay and readmissions were also assessed. Results: RAI assessments were completed on 36,261 unique patients presenting to surgical clinics across five hospitals from July 1 to December 31, 2016, and 8,172 of these underwent NSQIP-eligible surgical procedures. The mean RAI score was 23.6 (SD 11.2), the overall 30-day and 180-day mortality after surgery was 0.7% and 2.6%, respectively, and the median time required to collect the RAI was 33 [IQR 23-53] seconds. Overall clinic compliance with the recommendation for RAI assessment increased from 58% in the first month of the study period to 84% in the sixth and final month. RAI score was significantly associated with risk of death (HR=1.099 [95% C.I.: 1.091 - 1.106], p < 0.001). At an RAI cutoff of ≥37, the positive predictive values for 30- and 90-day readmission were 14.8% and 26.2%, respectively, and negative predictive values were 91.6% and 86.4%, respectively. Conclusions: The RAI frailty screening tool can be efficiently implemented within multi-specialty, multi-hospital healthcare systems. In the context of our findings and given the value of the RAI in predicting adverse postoperative outcomes, health systems should consider implementing frailty screening within surgical clinics. Competing Interests: The authors report no conflicts of interest. (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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