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Review
. 2023 Mar 9;23(1):136.
doi: 10.1186/s12877-023-03870-w.

Using electronic consultation (eConsult) to identify frailty in provider-to-provider communication: a feasibility and validation study

Ramtin Hakimjavadi  1   2 , Sathya Karunananthan  2   3 , Celeste Fung  4   5 , Cheryl Levi  6 , Mary Helmer-Smith  7 , James LaPlante  2 , Mohamed Gazarin  8 , Arya Rahgozar  4 , Amir Afkham  9   10 , Erin Keely  10   11 , Clare Liddy  12   13   14
Affiliations
Review

Using electronic consultation (eConsult) to identify frailty in provider-to-provider communication: a feasibility and validation study

Ramtin Hakimjavadi et al. BMC Geriatr. .

Abstract

Background: Frailty is a complex age-related clinical condition that increases vulnerability to stressors. Early recognition of frailty is challenging. While primary care providers (PCPs) serve as the first point of contact for most older adults, convenient tools for identifying frailty in primary care are lacking. Electronic consultation (eConsult), a platform connecting PCPs to specialists, is a rich source of provider-to-provider communication data. Text-based patient descriptions on eConsult may provide opportunities for earlier identification of frailty. We sought to explore the feasibility and validity of identifying frailty status using eConsult data.

Methods: eConsult cases closed in 2019 and submitted on behalf of long-term care (LTC) residents or community-dwelling older adults were sampled. A list of frailty-related terms was compiled through a review of the literature and consultation with experts. To identify frailty, eConsult text was parsed to measure the frequency of frailty-related terms. Feasibility of this approach was assessed by examining the availability of frailty-related terms in eConsult communication logs, and by asking clinicians to indicate whether they can assess likelihood of frailty by reviewing the cases. Construct validity was assessed by comparing the number of frailty-related terms in cases about LTC residents with those about community-dwelling older adults. Criterion validity was assessed by comparing clinicians' ratings of frailty to the frequency of frailty-related terms.

Results: One hundred thirteen LTC and 112 community cases were included. Frailty-related terms identified per case averaged 4.55 ± 3.95 in LTC and 1.96 ± 2.68 in the community (p < .001). Clinicians consistently rated cases with ≥ 5 frailty-related terms as highly likely of living with frailty.

Conclusions: The availability of frailty-related terms establishes the feasibility of using provider-to-provider communication on eConsult to identify patients with high likelihood of living with this condition. The higher average of frailty-related terms in LTC (versus community) cases, and agreement between clinician-provided frailty ratings and the frequency of frailty-related terms, support the validity of an eConsult-based approach to identifying frailty. There is potential for eConsult to be used as a case-finding tool in primary care for early recognition and proactive initiation of care processes for older patients living with frailty.

Keywords: Electronic consultation; Frailty; Identification; Telemedicine; Unstructured data.

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Conflict of interest statement

Drs. Liddy and Keely, and Amir Afkham are co-founders of the Champlain BASE™ eConsult Service, but they have no commercial interest in the service and do not retain any proprietary rights. Dr. Liddy and Keely are co-executive Directors of the Ontario eConsult Centre of Excellence and receive salary support from the Ontario Ministry of Health. Dr. Keely answers occasional eConsults (less than 1 per month) as a specialist through the service, for which she is reimbursed. Other authors report none.

Figures

Fig. 1
Fig. 1
Distribution of long-term care cases and community cases by number of frailty-related terms in the complete PCP-specialist eConsult communication. LTC, long-term care
Fig. 2
Fig. 2
Clinician-provided frailty ratings. For each eConsult case, clinicians provided two frailty ratings to assign a likelihood that the patient described in the communication logs is living with frailty. A greater rating corresponds with a higher likelihood of living with frailty. a Clinician-provided frailty ratings after reading only the PCP’s initial communication in the submitted eConsult. LTC, long-term care; PCP, primary care provider. b Clinician-provided frailty ratings for frailty after reading the entire PCP-specialist eConsult interaction. LTC, long-term care
Fig. 3
Fig. 3
Plot of the clinician-provided frailty ratings against the number of frailty-related terms identified in the eConsult text. FR, frailty rating
See this image and copyright information in PMC

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