The Oxford and Reading Cognitive Comorbidity, Frailty and Ageing Research Database exploiting hospital Electronic Patient Records (ORCHARD-EPR): protocol

Abstract

With population ageing, a wide range of hospital specialties now manage older people with complex conditions and cognitive or physically frailty with associated poor outcomes as highlighted in current guidelines aimed at improving care. However, to implement guidelines, secure resources and undertake clinically-meaningful audit/research, hospital data systems must be able identify and quantify patients with complexity and cognitive and physical frailty. The advent of hospital electronic patient records (EPRs) offers the opportunity to exploit large scale routinely acquired data at scale without additional burden to patients or staff at relatively low cost and without selection. EPRs provide considerably richer data, and in real-time, compared to retrospective administrative datasets based on ICD-10 coded diagnoses in which clinical complexity is often poorly captured. We therefore set-up the Oxford and Reading Comorbidity Frailty and Ageing Research Database exploiting hospital Electronic Patient Records (ORCHARD-EPR).

Methods

ORCHARD-EPR uses routinely-acquired individual patient data on all patients aged >65 years with unplanned admission or Same Day Emergency Care unit attendance at Oxford University Hospitals NHS Foundation Trust-OUHFT (comprising four acute general hospitals serving a population of >800,000) with the plan to extend to Royal Berkshire NHS Foundation Trust (>1,000,000). Datafields include diagnosis, comorbidities, nursing risk assessments, frailty, observations, illness acuity, laboratory tests and raw brain scan images. Importantly, ORCHARD-EPR contains the results from mandatory hospital-wide cognitive screening (>70 years) comprising the 10-point Abbreviated Mental Test and dementia and delirium diagnosis (Confusion Assessment Method-CAM). Outcomes include length of stay, delayed transfers of care, discharge destination, readmissions, and death. The rich multimodal data are further enhanced by linkage to secondary care electronic mental health records. Selection of appropriate subgroups or linkage to existing cohorts allows disease specific studies.Over 200,000 patient episodes are included (2015-2021) of which 129,248 are admissions with a LOS >1 day in 64,641 unique patients.

Discussion

ORCHARD-EPR contains rich, multimodal real-world electronic hospital data which will enable accurate phenotyping of cognitive and physical frailty including in disease-specific studies, and risk prediction for outcomes including dementia, thereby filling existing knowledge gaps and informing the design, delivery and resourcing of clinical services.