title: Integrated information for integrated care in the general practice setting in Italy: using social network analysis to go beyond the diagnosis of frailty in the elderly.
abstract: BACKGROUND
  Frailty has been defined in different ways and several diagnostic tools exist, but most of them are not applicable in routine primary care. Nonetheless, general practitioners (GPs) have a natural advantage in identifying frailty, due to their continued access to patients, patient-centered approach and training. GPs have also an advantage in conducting population-based evaluation as consequence of their role of gatekeepers of the health care system. This paper aims to identify those socio-demographic and clinical profiles and the relative information sources that, from the GPs' perspective, act as frailty markers, not solely as a diagnosis of state but as the ability to identify a patient's trajectory, over time, through the aging process.
  
  
  METHODS
  This study was performed as a survey within a population aged 75 and over, attending 148 GPs in Italy. A total of 23,996 patients were classified by GPs in distinct frailty status, without the use of a specific evaluation tool, but only referring to general indications. Co-morbidity was objectively assessed by a record-linkage with previous hospitalizations, in order to assess the occurrence of previous illnesses that could be associated with the likelihood of being identified as frails or at risk. The methodological approach is based on social network analysis (SNA), suited to explore relational aspects of complex phenomena.
  
  
  RESULTS
  Our findings reveal that GPs are able to perform low cost population-based evaluation, by exploiting the advantages of their approach to patients, combined with the information derived from their daily practice and from other sources currently available.
  
  
  CONCLUSIONS
  We believe that informative integration among different sources of available data can provide a comprehensive picture of the health state of patients in a shorter time and at lower cost. The identification of limited patient trajectories based on these observations can enable the development of critical biomarkers/diagnostics and prognostic indicators that will enhance patient care and potentially reduce inappropriate healthcare use. We also believe that network analysis is an extremely flexible research tool and a rich theoretical paradigm, and it may be used in the healthcare planning.
authors.affiliation: Institute of Clinical Physiology, Italian National Research Council-CNR, Via Moruzzi, 1, 56124, Pisa, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Franchini
authors.affiliation: Institute of Clinical Physiology, Italian National Research Council-CNR, Via Moruzzi, 1, 56124, Pisa, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Pieroni
authors.affiliation: Institute of Clinical Physiology, Italian National Research Council-CNR, Via Moruzzi, 1, 56124, Pisa, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Fortunato
authors.affiliation: Institute of Clinical Physiology, Italian National Research Council-CNR, Via Moruzzi, 1, 56124, Pisa, Italy.
authors.forename: Tamara
authors.initials: T
authors.lastname: Knezevic
authors.affiliation: IPQ Analytics, LLC/Strategic Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Liebman
authors.affiliation: Institute of Clinical Physiology, Italian National Research Council-CNR, Via Moruzzi, 1, 56124, Pisa, Italy. molinaro@ifc.cnr.it.
authors.forename: Sabrina
authors.identifier: http://orcid.org/0000-0002-1140-0312
authors.initials: S
authors.lastname: Molinaro
keywords: Data linkage; Disease trajectory; Elderly; Frailty; General practice; Population-based planning; Social network analysis