Updating and Validating the U.S. Veterans Affairs Frailty Index: Transitioning From ICD-9 to ICD-10. (9th March 2021)

• Record Type: Journal Article
• Authors: Cheng, David; DuMontier, Clark; Yildirim, Cenk; Charest, Brian; Hawley, Chelsea E; Zhuo, Min; Paik, Julie M; Yaksic, Enzo; Gaziano, J Michael; Do, Nhan; Brophy, Mary; Cho, Kelly; Kim, Dae H; Driver, Jane A; Fillmore, Nathanael R; Orkaby, Ariela R
• Editors: Newman, Anne B
• Is Part Of: Journals of gerontology. Volume 76:Number 7(2021)
• Page Start: 1318
• Page End: 1325
• Publication Date: 2021-03-09
• Subjects: Claims-based frailty index -- Electronic frailty index -- Epidemiology -- Frailty -- ICD 9–ICD-10 transition; Geriatrics -- Periodicals; Gerontology -- Periodicals; 618.97
• DOI: 10.1093/gerona/glab071
• Languages: English
• ISSNs: 1079-5006

Abstract

Abstract: Background: The Veterans Affairs Frailty Index (VA-FI) is an electronic frailty index developed to measure frailty using administrative claims and electronic health records data in Veterans. An update to ICD-10 coding is needed to enable contemporary measurement of frailty. Method: International Classification of Diseases, ninth revision (ICD-9) codes from the original VA-FI were mapped to ICD-10 first using the Centers for Medicaid and Medicare Services (CMS) General Equivalence Mappings. The resulting ICD-10 codes were reviewed by 2 geriatricians. Using a national cohort of Veterans aged 65 years and older, the prevalence of deficits contributing to the VA-FI and associations between the VA-FI and mortality over years 2012–2018 were examined. Results: The updated VA-FI-10 includes 6422 codes representing 31 health deficits. Annual cohorts defined on October 1 of each year included 2 266 191 to 2 428 115 Veterans, for which the mean age was 76 years, 97%–98% were male, 78%–79% were White, and the mean VA-FI was 0.20–0.22. The VA-FI-10 deficits showed stability before and after the transition to ICD-10 in 2015, and maintained strong associations with mortality. Patients classified as frail (VA-FI > 0.2) consistently had a hazard of death more than 2 times higher than nonfrail patients (VA-FI ≤ 0.1). Distributions of frailty and associations with mortality varied with and without linkage to CMS data and with different assessment periods for capturing deficits. Conclusions: The updated VA-FI-10 maintains content validity, stability, and predictive validity for mortality in a contemporary cohort of Veterans aged 65 years and older, and may be applied to ICD-9 and ICD-10 claims data to measure frailty.