Implementation of initiative associated with increased referrals for frail patients and reduced postoperative mortality
By Elana Gotkine HealthDay Reporter
FRIDAY, March 3, 2023 (HealthDay News) — Implementation of a frailty screening initiative (FSI) is associated with increased referrals for frail patients undergoing surgery and with reduced postoperative mortality, according to a study published online Feb. 22 in JAMA Surgery.
Patrick R. Varley, M.D., from the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues conducted a quality improvement study to examine whether an FSI is associated with reduced late-term mortality after elective surgery. Surgeons were incentivized to measure frailty with the Risk Analysis Index (RAI) for all patients considering elective surgery beginning in July 2016. The Epic Best Practice Alert (BPA), which was used to identify patients with frailty (RAI ≥42) and prompt surgeons to document a frailty-informed shared decision-making process, was implemented in February 2018.
Data were included for 50,463 patients with at least one year of follow-up after surgery: 22,722 and 27,741 before and after implantation of the intervention. The researchers found that the proportion of frail patients referred to a primary care physician and presurgical care clinic increased significantly after BPA implementation (9.8 to 24.6 percent and 1.3 to 11.4 percent, respectively). The odds of one-year mortality were reduced significantly in a multivariable regression analysis (odds ratio, 0.82). From the preintervention to postintervention period, there was a significant slope change in the rate of 365-day mortality from 0.12 to −0.04 percent. The estimated one-year mortality changed by −4.2 percent among patients triggering the BPA.
“Future efforts should focus on identifying methods to implement frailty screening in a broad range of practice settings as well as identify a suite of interventions best suited to improving outcomes for frail patients prior to surgery,” the authors write.
Two authors disclosed financial ties to FutureAssure.
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