title: Predictive validity of a two-step tool to map frailty in primary care.
abstract: BACKGROUND
  EASY-Care Two step Older people Screening (EASY-Care TOS) is a stepped approach to identify frail older people at risk for negative health outcomes in primary care, and makes use of General Practitioners' (GPs) readily-available information. We aimed to determine the predictive value of EASY-Care TOS for negative health outcomes within the year from assessment.
  
  
  METHODS
  A total of 587 patients of four GP practices in and around Nijmegen (The Netherlands) consented to participate in a longitudinal primary care registry based cohort study. Participants' frailty was judged by their GP following the EASY-Care TOS procedure and by a Comprehensive Geriatric Assessment (CGA) at baseline. After one year health outcomes of the participants were measured by reassessment with the EASY-Care TOS procedure.
  
  
  RESULTS
  Follow up information was available for 520 of 587 participants. In the non-frail group 9% showed any negative health outcomes (death, ADL decline, institutionalisation, too ill to undergo assessment), against 30% in the frail group (95% confidence interval of the difference (CI): 14%-28%). Area under the receiver operating curve (AUC) of the EASY-Care TOS frailty judgement for a composite of negative health outcomes mentioned was 0.67 (95% CI: 0.62-0.73). Compared with discrimination on the basis of age, sex and GP practice (AUC 0.70), adding EASY-Care TOS frailty judgement increased the AUC to 0.75 (+0.05, p = 0.02). The AUC on the basis of a full CGA is almost comparable to the AUC of the model with age, sex, and frailty judgement with EASY-Care TOS: 0.76 (+0.07, p = 0.005).
  
  
  CONCLUSIONS
  GPs applying the EASY-Care TOS procedure, where they only perform additional assessment when they judge this as necessary, can predict negative health outcomes in their older populations efficiently and almost as accurately as a complete specialist CGA.
authors.affiliation: Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. BOX 9101, 6500 HB, Nijmegen, The Netherlands. jalvankempen@gmail.com.
authors.forename: Janneke A L
authors.initials: JA
authors.lastname: van Kempen
authors.affiliation: Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud Institute for Health Sciences, Radboud University Medical Centre, P.O. BOX 9101, 6500 HB, Nijmegen, The Netherlands. henk.schers@radboudumc.nl.
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Schers
authors.affiliation: Heart of England NHS Trust, Netherwood House, Solihull Hospital, Lode Lane, Solihull, B91 2LJ, UK. ian.philp@heartofengland.nhs.uk.
authors.forename: Ian
authors.initials: I
authors.lastname: Philp
authors.affiliation: Department of Geriatric Medicine, Donders Centre for Neuroscience, Radboud University Medical Centre, P.O. BOX 9101, 6500 HB, Nijmegen, The Netherlands. marcel.olderikkert@radboudumc.nl.
authors.forename: Marcel G M
authors.initials: MG
authors.lastname: Olde Rikkert
authors.affiliation: Department of Geriatric Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. BOX 9101, 6500 HB, Nijmegen, The Netherlands. rene.melis@radboudumc.nl.
authors.forename: René J F
authors.initials: RJ
authors.lastname: Melis
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000379:methods*