Predicting readmission and death after hospital discharge: a comparison of conventional frailty measurement with an electronic health record-based score

Age Ageing. 2021 Sep 11;50(5):1641-1648. doi: 10.1093/ageing/afab043.


Background: frailty measurement may identify patients at risk of decline after hospital discharge, but many measures require specialist review and/or additional testing.

Objective: to compare validated frailty tools with routine electronic health record (EHR) data at hospital discharge, for associations with readmission or death.

Design: observational cohort study.

Setting: hospital ward.

Subjects: consented cardiology inpatients ≥70 years old within 24 hours of discharge.

Methods: patients underwent Fried, Short Physical Performance Battery (SPPB), PRISMA-7 and Clinical Frailty Scale (CFS) assessments. An EHR risk score was derived from the proportion of 31 possible frailty markers present. Electronic follow-up was completed for a primary outcome of 90-day readmission or death. Secondary outcomes were mortality and days alive at home ('home time') at 12 months.

Results: in total, 186 patients were included (79 ± 6 years old, 64% males). The primary outcome occurred in 55 (30%) patients. Fried (hazard ratio [HR] 1.47 per standard deviation [SD] increase, 95% confidence interval [CI] 1.18-1.81, P < 0.001), CFS (HR 1.24 per SD increase, 95% CI 1.01-1.51, P = 0.04) and EHR risk scores (HR 1.35 per SD increase, 95% CI 1.02-1.78, P = 0.04) were independently associated with the primary outcome after adjustment for age, sex and co-morbidity, but the SPPB and PRISMA-7 were not. The EHR risk score was independently associated with mortality and home time at 12 months.

Conclusions: frailty measurement at hospital discharge identifies patients at risk of poorer outcomes. An EHR-based risk score appeared equivalent to validated frailty tools and may be automated to screen patients at scale, but this requires further validation.

Keywords: co-morbidity; frailty; older people; risk prediction.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Electronic Health Records
  • Female
  • Frail Elderly
  • Frailty* / diagnosis
  • Hospitals
  • Humans
  • Male
  • Patient Discharge
  • Patient Readmission