J.A.L. van Kempen, H.J. Schers, I. Philp, M.G.M. O. Rikkert, R.J.F. Melis

BMC Medicine 2015;13:287

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. This study aimed to determine the predictive value of EASY-Care TOS for negative health outcomes within the year from assessment.

The first step is a simple triage tool with which the general practitioner (GP) makes a pre-selection of older people based on his prior patient knowledge and information. Further information is only gathered when the GP considers this necessary. To complete this first step, the GP reviews the patient record and answers 14 questions about the functioning of the patient in somatic, psychological, and social domains. The GPs decide whether: (1) the patient is not frail; (2) the patient is frail; or (3) the available information is insufficient for a decision (unclear). Only persons in whom the GP judges the available information to be insufficient for a decision receive a structured assessment using the EASY-Care assessment instrument by a primary care nurse (step 2). This EASY-Care assessment takes place in the patient’s own home.

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.

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 judgment 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 judgment 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 judgment with EASY-Care TOS: 0.76 (+0.07,p = 0.005).

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.