The CIHI HFRM is a contextual measure, not a health indicator intended to benchmark performance.
The higher the value of the continuous CIHI HFRM, the more deficits a patient had accumulated and that were used to determine their risk of frailty.
The 8 risk groups represent frailty risk in terms of risk severity from lowest (group 1) to highest (group 8). The higher the number of the risk group, the more deficits that patient accumulated. Risk groups 4 to 8 are used to identify Hospitalized Seniors (65+) at Risk of Frailty (%).
As higher levels of frailty are linked to a number of adverse outcomes among seniors, when frailty severity increases, so does the risk for these adverse outcomes. Please refer to the CIHI HFRM methodology notes (PDF) for details.
For more information on frailty, please refer to the Frailty web page.
Unit of Analysis: Patient
The CIHI HFRM follows a cumulative deficit approach (i.e., an accumulation of deficits is used to determine the individual’s risk of frailty).
The list of frailty deficits used for the CIHI HFRM includes 36 frailty condition categories, each of which corresponds to diagnosis codes from the ICD-10-CA. The list covers frailty-related deficits such as morbidity, function, sensory loss, cognition and mood.
An individual patient’s risk of frailty is calculated over a period of 2 years by counting the number of deficits, or frailty condition categories, looking back 2 years from their index discharge date, which is the most recent acute care inpatient discharge in the reporting year.
For more detailed information on how the condition categories were identified or how patient records were linked, please see the CIHI HFRM methodology notes (PDF).
Results are presented in 3 different ways:
1) As a continuous CIHI HFRM score
To calculate the continuous score per patient, the total number of deficits for each patient is divided by 36, which is the maximum number of deficits a patient can theoretically accumulate. The resulting value is a number in a continuous range between 0 and 1.
Grouping of the CIHI HFRM into meaningful risk categories provides a better description of the seniors patient population, as opposed to a single continuous measure that ranges between 0 and 1.
Therefore, the following are also presented:
2) 8 risk groups
Patients are grouped into 8 categorical risk groups according to their total number of deficits, ranging in severity from lowest (group 1) to highest risk (group 8). The 8 risk groups are presented as a percentage of patients in each of the 8 groups.
3) Hospitalized Seniors (65+) at Risk of Frailty (%)
As a single measure of frailty risk, this is the proportion of patients in risk groups 4 to 8 divided by all patients included in the frailty cohort. This is the measure reported in the Your Health System: In Depth tool.
Results are reported at the hospital, region and province/territory levels. Patients are included in the results for each hospital from which they were discharged. (Note: Patients are included only once in results for each hospital, region and province/territory.)
For results at the hospital level, place of service is used; for region and province/territory results, the patient’s place of residence is used.
For more information on the CIHI HFRM calculation, as well as on how patients were assigned to risk groups and flagged as being at risk of frailty, please refer to the CIHI HFRM methodology notes (PDF).
Patients age 65 and older discharged from an acute care hospital
See Calculation: Description.
Comments
More information on the CIHI HFRM is available on the Frailty web page, the CIHI HFRM FAQ and the CIHI HFRM methodology notes (PDF)