Andrew Street joined the Department of Health Policy at the London School of Economics in September 2017 and is currently Head of Department. Previously he was at the University of York, which he joined in 1995, and where he was Director of the Health Policy team in the Centre for Health Economics and Director of the Economics of Social and Health Care Research Unit (ESHCRU). He has worked on secondment for health ministries in Australia (1993) and England (2005), and has served as editor of the Journal of Health Economics (2006-2018), board member of the NIHR Health Services and Delivery Research Commissioning Board (2010-2017) and the Research Council of Norway’s Health and Care Services Board (2011-2013), and as specialist advisor to the House of Commons Health & Care Committee for budget related inquiries (2016-2019).  Andrew has published over 130 peer-reviewed journal articles on topics including health system productivity, hospital efficiency, hospital payment arrangements and DRG-funding, organisational performance measurement, patient reported outcomes, integrated health and social care, frailty assessment of older people, and econometric analyses of variation among patients in costs, length of stay and outcomes.

Abstract:

Frailty is a well-established concept in the care of older people, having been shown to be a powerful marker of the risk of adverse outcomes in diverse populations of older people in a wide range of settings. This paper introduces the Hospital Frailty Risk Score (HFRS), which was developed to assess the frailty risk using routinely collected hospital data. The HFRS can be calculated for all hospitalised patients by combining a weighted set of 109 3-character ICD-10 diagnostic codes. Originally developed to assess frailty among patients 75+, the HFRS has since been validated in numerous international studies. It has been consistently found that higher frailty risk scores are associated with longer length of stay in hospital, a higher probability of in-hospital death, and higher hospital costs among older patients. In this presentation I first describe the construction of the HFRS and then report results of applying the measure to hospitalised adults of any age showing that, even among younger adults, frailty risk is associated with adverse outcomes. Use of the HFRS thus permits hospitals and health care systems to efficiently identify individuals or clusters of patients who might benefit from special attention when admitted to hospital.

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