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Application of an electronic Frailty Index in Australian primary care: data quality and feasibility assessment



The primary care setting is the ideal location for identifying the condition of frailty in older adults.


The aim of this pragmatic study was twofold: (1) to identify data items to extract the data required for an electronic Frailty Index (eFI) from electronic health records (EHRs); and (2) test the ability of an eFI to accurately and feasibly identify frailty in older adults.


In a rural South Australian primary care clinic, we derived an eFI from routinely collected EHRs using methodology described by Clegg et al. We assessed feasibility and accuracy of the eFI, including complexities in data extraction. The reference standard for comparison was Fried’s frailty phenotype.


The mean (SD) age of participants was 80.2 (4.8) years, with 36 (60.0%) female (n = 60). Frailty prevalence was 21.7% by Fried’s frailty phenotype, and 35.0% by eFI (scores > 0.21). When deriving the eFI, 85% of EHRs were perceived as easy or neutral difficulty to extract the required data from. Complexities in data extraction were present in EHRs of patients with multiple health problems and/or where the majority of data items were located other than on the patient’s summary problem list.


This study demonstrated that it is entirely feasible to extract an eFI from routinely collected Australian primary care data. We have outlined a process for extracting an eFI from EHRs without needing to modify existing infrastructure. Results from this study can inform the development of automated eFIs, including which data items to best access data from.

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ED received support from an Australian National Health and Medical Research Council (NHMRC) Grant: #1112672. This research is supported by an NHMRC Centre of Research Excellence in Transdisciplinary Frailty Research to Achieve Healthy Ageing (Grant: #1102208). MA acknowledges fellowship support received from the Canadian Institutes of Health Research and the NHMRC in support of her postdoctoral research.

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Corresponding author

Correspondence to Rachel C. Ambagtsheer.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Statement of human and animal rights

This study received ethics approval from the Torrens University HREC Committee (#H1/18) and was conducted in accordance with the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study.



See Table 3.

Table 3 Comparison of frailty status according to eFI and phenotype

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Ambagtsheer, R.C., Beilby, J., Dabravolskaj, J. et al. Application of an electronic Frailty Index in Australian primary care: data quality and feasibility assessment. Aging Clin Exp Res 31, 653–660 (2019).

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  • Electronic health records
  • Frailty
  • Aged, 80 and over
  • Geriatric assessment
  • Primary health care