“The classification of patients according to their level of frailty allows us to adjust prevention programs and focus our limited resources on the right action for the right person”

A new research paper was published in Aging (listed by MEDLINE/PubMed as "Aging (Albany NY)" and "Aging-US" by Web of Science), on October 24, 2024, Volume 16, Issue 20, titled, "Development and validation of an electronic frailty index in a national health maintenance organization."

The study, led by researchers Fabienne Hershkowitz Sikron, Rony Schenker, Yishay Koom, Galit Segal, Orit Shahar, Idit Wolf, Bawkat Mazengya, Maor Lewis,  Irit Laxer and Dov Albukrek from Meuhedet Health Maintenance Organization (HMO) in collaboration with colleagues from the Joint-Eshel Organization and the  Israeli Ministry of Health, introduces the Meuhedet Electronic Frailty Index (MEFI)—a digital tool designed to assess frailty in older people and identify those most at risk for serious health outcomes, such as hospitalization or death.

As people live longer, identifying those at higher risk for health complications is essential to maintaining quality of life in older age. Frailty, a condition marked by increased vulnerability to adverse health outcomes, has emerged as a crucial predictor of health deterioration in older people. While frailty assessment tools exist, this study adapts and validates an Electronic Frailty Index (EFI) tailored specifically to Israeli data and healthcare infrastructure, enabling more targeted and culturally relevant assessments.

The MEFI was developed using data from 120,986 individuals aged 65 and older, comprising different indicators, including physical, social, and cognitive deficits. The index classifies individuals as "fit," "mildly frail," "moderately frail," or "severely frail" and is integrated into Israel’s electronic health records system.

Researchers found that patients with higher MEFI scores faced significantly increased risks of hospitalization or mortality within one year, with risk levels rising fourfold for the most frail compared to those classified as fit. According to the authors, “The findings also showed that the MEFI version we created is valid in predicting mortality or hospitalization and had better predictive accuracy compared to CCI,” underscoring its reliability in assessing health risks. This integration enables Meuhedet HMO to implement proactive and preventive care measures across its network.

Beyond predicting hospitalization and mortality, the MEFI’s alignment with Israel’s National Social Security benefit system reinforces its validity and practical use. As the authors note, “As a health maintenance organization, our mandate is to help our patients live longer and better. Using the MEFI as part of routine primary care may help us achieve this goal.” By focusing on early intervention for those most at risk, MEFI could significantly impact health maintenance costs and enable clinicians to allocate resources more effectively.

This new EFI version positions Israel at the forefront of frailty research, and its success could pave the way for other countries with similar healthcare systems to adopt or adapt the approach. Future steps include integrating MEFI as a routine part of primary care in Israel to ensure timely intervention and support as patients age.

In summary, MEFI is a powerful tool that empowers Israel’s healthcare system to identify and support older adults most in need, marking a significant advancement in caring for an aging population.