Construction of a Frailty Indicator with Partially Ordered Sets: A Multiple-Outcome Proposal Based on Administrative Hea
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Construction of a Frailty Indicator with Partially Ordered Sets: A Multiple‑Outcome Proposal Based on Administrative Healthcare Data Margherita Silan1 · Giada Signorin1 · Elisa Ferracin2 · Elisabetta Listorti2,3 · Teresa Spadea2 · Giuseppe Costa2 · Giovanna Boccuzzo1 Accepted: 3 October 2020 © The Author(s) 2020
Abstract Given the progressive aging of Italian and European populations, the number of cases with chronic diseases is steeply increasing. This calls for new strategies for health resource management and the implementation of prevention policies. Among chronic patients, frail subjects have special and wider care requirements, along with an increased risk of adverse health outcomes. Thus, their identification is an important step for the Italian National Program for Chronic Diseases. This study aims at constructing an indicator that measures the frailty level of individuals in the population aged over 65 y using administrative healthcare data-flows of the Piedmont region. Following the multidimensional nature of frailty, we adopted a multiple-outcome approach in our proposal. This was done by considering the capacity to predict six unfavorable outcomes: death, urgent unplanned hospitalization, access to the emergency room with red code, avoidable hospitalization, hip fracture, and disability. We identified a parsimonious set of seven explanatory variables that can simultaneously predict the six outcomes we considered. We then assembled them into a unique frailty indicator through the use of a partially ordered set (poset) theory. Our indicator performed well with respect to all the outcomes and was able to describe several individual characteristics that are not directly considered in the computation of the indicator. Thanks to its parsimony and to the use of administrative healthcare data, our indicator allows all the stakeholders involved in the healthcare process, such as Italian Local Health Units, general practitioners, and regional managers, to use it to target frail individuals with better comprehensive healthcare actions. Keywords Frailty indicator · Administrative healthcare data · Poset theory · Aging · Multiple outcomes
* Margherita Silan [email protected] Extended author information available on the last page of the article
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1 Introduction Nowadays, the identification of frail individuals is quite a popular research theme. Despite the growing interest regarding this topic, a unique definition for frail individuals still does not exist, and frailty is still defined as a syndrome in desperate need of description and analysis (Gillick 2001). Indeed, the identification of both common criteria and guidelines for frailty has been described as a highly complex and demanding task (Bortz 2002). This is because frailty is a complex and multidimensional concept that involves several functional domains of the elderly (Gobbens et al. 2010). Attention toward the definition, measurement, and identification of frailty originates from the aging phenomenon. In fa
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