An electronic frailty index for population-level risk stratification in a large health maintenance organization: A cohort study

CeFI, an electronic frailty index built from 36 EHR deficits in 641,748 Clalit Health Services members aged ≥65, predicts one-year mortality with adjusted HR 6.33 for severe vs fit.

• Why it matters: Frailty quantification from routine EHR data is needed to enable scalable population-level risk stratification beyond in-person geriatric assessment.
• What they did: In a retrospective cohort split into development (n=321,019) and validation (n=320,729) sets, CeFI was computed as the proportion of 36 deficits from ICD-9 codes, registries, labs, vitals, procedures, and medications.
• The result: One-year mortality rose from 0.9% (CeFI ≤0.12) to 18.7% (CeFI >0.36), and hospitalization or death rose from 11.5% to 57.5%, with moderate correlation to CGA-FI (Spearman rho=0.49; Pearson r=0.51).