Performance of a Claims-Based Frailty Proxy Using Varying Frailty Ascertainment Lookback Windows.

Autor:	Duchesneau ED; Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC., Stürmer T; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC., Kim DH; Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Roslindale, MA.; Department of Medicine, Division of Gerontology, Beth Israel Deaconess Medical Center, Brookline, MA., Reeder-Hayes K; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.; Department of Medicine, Division of Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC., Edwards JK; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC., Faurot KR; Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina, Chapel Hill, NC., Lund JL; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Jazyk:	angličtina
Zdroj:	Medical care [Med Care] 2024 May 01; Vol. 62 (5), pp. 305-313. Date of Electronic Publication: 2024 Mar 12.
DOI:	10.1097/MLR.0000000000001994
Abstrakt:	Background: Frailty is an aging-related syndrome of reduced physiological reserve to maintain homeostasis. The Faurot frailty index has been validated as a Medicare claims-based proxy for predicting frailty using billing information from a user-specified ascertainment window. Objectives: We assessed the validity of the Faurot frailty index as a predictor of the frailty phenotype and 1-year mortality using varying frailty ascertainment windows. Research Design: We identified older adults (66+ y) in Round 5 (2015) of the National Health and Aging Trends Study with Medicare claims linkage. Gold standard frailty was assessed using the frailty phenotype. We calculated the Faurot frailty index using 3, 6, 8, and 12 months of claims prior to the survey or all-available lookback. Model performance for each window in predicting the frailty phenotype was assessed by quantifying calibration and discrimination. Predictive performance for 1-year mortality was assessed by estimating risk differences across claims-based frailty strata. Results: Among 4253 older adults, the 6 and 8-month windows had the best frailty phenotype calibration (calibration slopes: 0.88 and 0.87). All-available lookback had the best discrimination (C-statistic=0.780), but poor calibration. Mortality associations were strongest using a 3-month window and monotonically decreased with longer windows. Subgroup analyses revealed worse performance in Black and Hispanic individuals than counterparts. Conclusions: The optimal ascertainment window for the Faurot frailty index may depend on the clinical context, and researchers should consider tradeoffs between discrimination, calibration, and mortality. Sensitivity analyses using different durations can enhance the robustness of inferences. Research is needed to improve prediction across racial and ethnic groups. Competing Interests: T.S. receives salary support from the Center for Pharmacoepidemiology (current members: GlaxoSmithKline, UCB BioSciences, Takeda, AbbVie, Boehringer Ingelheim, As tellas, and Sarepta) and from a generous contribution from Dr. Nancy A. Dreyer to the Department of Epidemiology, University of North Carolina at Chapel Hill. T.S. does not accept personal compensation of any kind from any pharmaceutical company. He owns stock in Novartis, Roche, and Novo Nordisk. J.L.L. receives research support from Roche to the University of North Carolina; her spouse was formerly employed by GlaxoSmithKline and previously owned stock in the company. K.R-H. receives research support unrelated to this work from Pfizer Global Medical Foundation to the University of North Carolina. D.H.K. received personal fees from Alosa Health and VillageMD for unrelated work. The remaining authors, J.K.E., K.R.F., and E.D.D., declare no conflicts of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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