eFI-cacious™ Lab

The Electronic Frailty Index for Clinical Care in Older Adults.

eFI-catious Lab CHI Project Wake Forest University School of Medicine

With the eFI-cacious™ Lab, we are not only redefining what frailty means, but also how we determine a patient’s frailty. Our mission is to add value to the healthcare system and improve healthcare for older adults with frailty by implementing best evidence into practice and generating practice-based evidence. 

Frailty is a decreased reserve in both physiology and day-to-day function, leading to a vulnerability to acute stressors. This predicts worse health outcomes, including falls, burdensome healthcare utilization, and mortality. 


Why test for frailty?

With frailty, we don't "know it when we see it." In other words, our "eyeball test" is unreliable over 40% of the time.

Most frailty tools are time-consuming and laborious; however, the Electronic Frailty Index (eFI) tool runs in the background, mobilizing data that is already present in a patients electronic health record (EHR).

Based on a two-year, look-back period and calculated using more than 50 EHR data elements deriving from five categories (shown below), the eFI delivers providers a single, objective score. 

Medication List Function (e.g., daily activities) Medical Diagnoses 
Weight, BMI, and Blood Pressure Laboratory Tests (e.g., blood counts)  

eFI in Population Health

In coordination with Population Health, the eFI-cacious™ Lab is working to contact patients with present frailty during the COVID-19 pandemic to identify and address both medical and social needs. Our goal is to improve overall health while reducing burdensome healthcare utilization.

eFI and Healthcare Utilization

  Mean Cumulative Count
(per 100 individuals aged 65+)
Over 1 Year
Health Outcome:  "Fit" (eFI<0.1) "Frail" (eFI>0.21)  
Healthcare Visits 125.5 449.9 3.6
Emergency Department Visits 2.4 19.3 8.0
Hospitalizations 5.1 41.5 8.2
Injurious Falls 0.8 5.1 6.2
Citation: Pajewski N et al. 2019 Journals of Gerontology

eFI-cacious™ for Peri-operative Care

For both pre-operative counseling and peri-operative consultation, the eFI can be used as a risk assessment tool for providers. 
Potential outcomes using eFI-cacious™ for peri-operative care can result in a reduction of length of hospital stays, 30-day readmissions, loss of basic daily living activities, post-operative cognitive declines, and mortalities. 

Utilizing the Surgical Advocate and Geriatrics Educator (SAGE) Care Pathway Pilot, providers can better guide older adults through the peri-operative period. 

eFI-cacious™ for Diabetes Care

The eFI can also be applied as a means to identify individuals best served by de-intensifying Type 2 Diabetes regimens. Research found that “tight” glycemic control—defined as a hemoglobin a1c below target—can be dangerous for adults over the age of 65 with Type 2 Diabetes. 

Potential outcomes include reduction of hypoglycemic events, burdensome healthcare utilization, injurious falls, and mortality.