# Applications of Claims-Based Frailty Index to Advance Evidence for Frailty-Guided Decision-Making

> **NIH NIH R01** · HEBREW REHABILITATION CENTER FOR AGED · 2022 · $632,630

## Abstract

PROJECT SUMMARY/ABSTRACT
Older adults with frailty are more likely to experience poor health outcomes after acute illnesses, drug-related
adverse events, and surgeries. Health care costs for frail patients double due to acute hospital care, post-acute
care, and treatments for preventable conditions. Despite clinical and societal consequences of frailty, frailty is
rarely assessed in clinical practice and little evidence exists on how to integrate frailty to inform clinical care and
population health management. The critical step to generate this evidence is to measure frailty on a large scale
with high accuracy and efficiency. To address this need, the investigator team recently developed and validated
a claims-based frailty index (CFI), which enables measurement of frailty from Medicare data for large populations
when in-person assessment is not feasible. The objective of this application is to generate evidence needed for
frailty-guided clinical care and population health management by applying CFI to claims data-based studies of
drug therapy; pragmatic clinical trials of procedural therapy; and electronic health records (EHR)-Medicare linked
data of a health care system. The central hypothesis is that frailty information will improve care of older adults
by uncovering meaningful variations in the treatment benefit-harm profile, costs, and resource needs. To test
this hypothesis, the investigator team with extensive expertise in frailty, pharmacoepidemiologic methods, and
health services research will accomplish the following specific aims in the next 5 years: 1) determine how frailty
changes the benefits and harms of 10 prescription drugs for chronic conditions in older adults by applying CFI
to the 2014-2022 5% Medicare random sample; 2) determine how frailty changes the benefits and harms of
procedural therapies in older adults by applying CFI to Medicare data linked to 2 ongoing pragmatic clinical trials
of endovascular vs surgical revascularization therapy for peripheral arterial disease and acupuncture vs usual
care for chronic low back pain; and 3) determine whether implementing CFI to EHR-Medicare linked data can
predict high-cost and high-need patients in a large health care system in Boston, Massachusetts. The innovative
applications of CFI are readily scalable to claims-based comparative effectiveness and safety studies, clinical
trials, and EHR in health care systems. The impact of this research is significant because the clinically actionable
evidence generated from this research can enable optimal choice of drug and procedural therapy and a health
system-wide risk stratification based on frailty. Ultimately, these results will accelerate integration of frailty in
routine care and facilitate frailty-guided clinical care and population health management.

## Key facts

- **NIH application ID:** 10475831
- **Project number:** 5R01AG071809-02
- **Recipient organization:** HEBREW REHABILITATION CENTER FOR AGED
- **Principal Investigator:** Dae Hyun Kim
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $632,630
- **Award type:** 5
- **Project period:** 2021-09-01 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10475831

## Citation

> US National Institutes of Health, RePORTER application 10475831, Applications of Claims-Based Frailty Index to Advance Evidence for Frailty-Guided Decision-Making (5R01AG071809-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10475831. Licensed CC0.

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