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. 2018 Jun 14;73(7):980-987.
doi: 10.1093/gerona/glx229.

Measuring Frailty in Medicare Data: Development and Validation of a Claims-Based Frailty Index

Dae Hyun Kim  1   2 , Sebastian Schneeweiss  1 , Robert J Glynn  1   3 , Lewis A Lipsitz  2   4 , Kenneth Rockwood  5 , Jerry Avorn  1
Affiliations

Measuring Frailty in Medicare Data: Development and Validation of a Claims-Based Frailty Index

Dae Hyun Kim et al. J Gerontol A Biol Sci Med Sci. .

Abstract

Background: Frailty is a key determinant of health status and outcomes of health care interventions in older adults that is not readily measured in Medicare data. This study aimed to develop and validate a claims-based frailty index (CFI).

Methods: We used data from Medicare Current Beneficiary Survey 2006 (development sample: n = 5,593) and 2011 (validation sample: n = 4,424). A CFI was developed using the 2006 claims data to approximate a survey-based frailty index (SFI) calculated from the 2006 survey data as a reference standard. We compared CFI to combined comorbidity index (CCI) in the ability to predict death, disability, recurrent falls, and health care utilization in 2007. As validation, we calculated a CFI using the 2011 claims data to predict these outcomes in 2012.

Results: The CFI was correlated with SFI (correlation coefficient: 0.60). In the development sample, CFI was similar to CCI in predicting mortality (C statistic: 0.77 vs. 0.78), but better than CCI for disability, mobility impairment, and recurrent falls (C statistic: 0.62-0.66 vs. 0.56-0.60). Although both indices similarly explained the variation in hospital days, CFI outperformed CCI in explaining the variation in skilled nursing facility days. Adding CFI to age, sex, and CCI improved prediction. In the validation sample, CFI and CCI performed similarly for mortality (C statistic: 0.71 vs. 0.72). Other results were comparable to those from the development sample.

Conclusion: A novel frailty index can measure the risk for adverse health outcomes that is not otherwise quantified using demographic characteristics and traditional comorbidity measures in Medicare data.

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Figures

Figure 1.
Figure 1.
Distribution of survey-based and claims-based frailty index in medicare current beneficiary survey. (A, B) The age and sex-specific mean (node) and standard deviation (vertical bar) were displayed for survey-based frailty index (SFI) and claims-based frailty index (CFI). Both frailty indices increased with age (p < .05) and were higher in women than men (p < .05). (C) The mean (node) and standard deviation (vertical bar) of the SFI were plotted for the deciles of the CFI.
See this image and copyright information in PMC

Comment in

  • Claims-Based Frailty Index Options.
    Segal JB, Varadhan R, Carlson MC, Walston JD. Segal JB, et al. J Gerontol A Biol Sci Med Sci. 2018 Jun 14;73(7):988. doi: 10.1093/gerona/gly055. J Gerontol A Biol Sci Med Sci. 2018. PMID: 29697751 No abstract available.

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