Virtual frailty screening: A quality improvement project to enhance community-based assessment

Background

Conventional approaches to frailty assessment rely on in-person evaluation by health professionals in medical settings. The COVID-19 pandemic drastically limited access to both primary care and face-to-face appointments, highlighting a need for novel and forward-thinking frailty screening methods to bridge this gap. Community-based seniors-serving organizations are well-positioned to implement remote frailty assessment, given its potential to enhance virtual services and referrals.

Methods

The Clinical Frailty Scale (CFS) was adapted and implemented as Virtual Frailty Screening (VFS), using the Plan-Do-Study-Act (PDSA) framework, in an inner-city organization for older adults. Participants participated in phone assessments by social workers (SWs); in-person visits included the CFS for comparative purposes. As a component of our larger quality improvement initiative, pilot data were analyzed descriptively alongside inferential methods consisting of Kendall's τ_b, Χ²-test of association, and Wilcoxon matched-pairs signed-rank test.

Results

Over 101 older adults were screened, with 79.21 % being assigned as very mild to moderately frail. VFS usage enabled crucial referrals for 70 older adults to receive long-term frailty-specific support and services in the community. Analysis found that the VFS performed similarly to the CFS, established by high convergent validity and alignment between both scales.

Conclusions

Findings support the implementation of remote frailty assessment by SWs in community-based seniors serving organizations. This integration bridges immediate service gaps, introducing a transformative approach to frailty assessment which has the potential for scalability. Success was attributed to a multidisciplinary approach with rapid PDSA changes in a nimble organization.