Validation of the JEN frailty index in the National Long-Term Care Survey community population: identifying functionally impaired older adults from claims data

• Published in: BMC health services research Vol. 18; no. 1; p. 908
• Main Authors: Kinosian, Bruce, Wieland, Darryl, Gu, Xiliang, Stallard, Eric, Phibbs, Ciaran S, Intrator, Orna
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29.11.2018; BioMed Central; BMC
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Analysis; Beneficiaries; Calibration; Care and treatment; Community-based; Comorbidity; Deficit accumulation; Dependency, Psychological; Disability; Discrimination; Electronic health records; Expenditures; Female; Frail elderly; Frailty; Functional performance; Geriatric Assessment - methods; Geriatrics; Health aspects; Health services; Humans; Institutionalization; Institutionalization - statistics & numerical data; Interviews; Logistic Models; Long term care; Long term health care; Long-Term Care - statistics & numerical data; Male; Medicaid; Medicare; Medicare - statistics & numerical data; Mental disorders; Older people; Population health management; Psychological aspects; Regression analysis; Risk Factors; ROC Curve; Surveys and Questionnaires; Treatment outcome; United States; United States; United States > US; Deficit accumulation; Long-term institutionalization; Population health management; Health services; Mortality; Predictive validity; Community-based; Long term care; Functional performance
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-018-3689-2

Use of a claims-based index to identify persons with physical function impairment and at risk for long-term institutionalization would facilitate population health and comparative effectiveness research. The JEN Frailty Index [JFI] is comprised of diagnosis domains representing impairments and multimorbid clusters with high long-term institutionalization [LTI] risk. We test the index's discrimination of activities-of-daily-living [ADL] dependency and 1-year LTI and mortality in a nationally representative sample of over 12,000 Medicare beneficiaries, and compare long-term community survival stratified by ADL and JFI. 2004 U.S. National Long-Term Care Survey data were linked to Medicare, Minimum Data Set, Veterans Health Administration files and vital statistics. ADL dependencies, JFI score, age and sex were measured at baseline survey. ADL and JFI groups were cross-tabulated generating likelihood ratios and classification statistics. Logistic regression compared discrimination (areas under receiver operating characteristic curves), multivariable calibration and accuracy of the JFI and, separately, ADLs, in predicting 1-year outcomes. Hall-Wellner bands facilitated contrasts of JFI- and ADL-stratified 5-year community survival. Likelihood ratios rose evenly across JFI risk categories. Areas under the curves of functional dependency at ≥3 and ≥ 2 for JFI, age and sex models were 0.807 [95% c.i.: 0.795, 0.819] and 0.812 [0.801, 0.822], respectively. The area under the LTI curve for JFI and age (0.781 [0.747, 0.815]) discriminated less well than the ADL-based model (0.829 [0.799, 0.860]). Community survival separated by JFI strata was comparable to ADL strata. The JEN Frailty Index with demographic covariates is a valid claims-based measure of concurrent activities-of-daily-living impairments and future long-term institutionalization risk in older populations lacking functional information.