Frailty represents an integrative prognostic marker of risk that associates with a myriad of age-related adverse outcomes in older adults. As a concept, frailty can help to target scarce resources and identify subgroups of vulnerable older adults that may benefit from interventions or changes in medical management, such as pursing less aggressive glycaemic targets for frail older adults with diabetes. In practice, however, there are several operational challenges to implementing frailty screening outside the confines of geriatric medicine. Electronic frailty indices (eFIs) based on the theory of deficit accumulation, derived from routine data housed in the electronic health record, have emerged as a rapid, feasible and valid approach to screen for frailty at scale. The goal of this paper is to describe the early experience of three diverse groups in developing, implementing and adopting eFIs (The English National Health Service, US Department of Veterans Affairs and Atrium Health—Wake Forest Baptist). These groups span different countries and organisational complexity, using eFIs for both research and clinical care, and represent different levels of progress with clinical implementation. Using an implementation science framework, we describe common elements of successful implementation in these settings and set an agenda for future research and expansion of eFI-informed initiatives.

中文翻译：

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通过电子衰弱指数进行衰弱识别的新视野：英国和美国经验的早期实施经验教训

虚弱是一种综合预后风险标志，与老年人中多种与年龄相关的不良后果相关。作为一个概念，虚弱可以帮助瞄准稀缺资源，并确定可能受益于干预措施或医疗管理变化的弱势老年人亚群，例如为患有糖尿病的虚弱老年人追求不太激进的血糖目标。然而，在实践中，在老年医学范围之外实施衰弱筛查存在一些操作挑战。基于赤字累积理论的电子衰弱指数（eFI）源自电子健康记录中的常规数据，已成为大规模筛查衰弱的快速、可行且有效的方法。本文的目的是描述三个不同团体（英国国家卫生服务部、美国退伍军人事务部和 Atrium Health - Wake Forest Baptist）在开发、实施和采用 eFI 方面的早期经验。这些小组跨越不同的国家和组织复杂性，使用 eFI 进行研究和临床护理，并代表了临床实施的不同进展水平。我们使用实施科学框架，描述了在这些环境中成功实施的常见要素，并为未来研究和扩展 eFI 知情计划制定了议程。