Abstract
Background: Guidelines recommend that all older hospital patients are screened for cognitive comorbidity (i.e. dementia, delirium) and frailty to inform care and target multidisciplinary team resources, based mainly on evidence from studies in elective or specialty-specific settings. Unselected hospital-wide data are needed to inform guidance and service design and delivery, so we set up the Oxford Cognitive Comorbidity and Ageing Research Database (ORCHARD) using routinely-acquired electronic patient record (EPR) data.
Methods: ORCHARD includes pseudonymised EPR data on all patients >65 years with unplanned admission to one of four general hospitals in Oxfordshire, serving a population of 660,000. Data collected include cognitive screening (mandatory for >70 years) comprising dementia history, delirium diagnosis (Confusion Assessment Method—CAM), and 10-point Abbreviated Mental Test; together with nursing risk assessments, frailty, diagnoses, comorbidities (Charlson index), observations, illness acuity, laboratory tests and brain imaging. Outcomes include length of stay, delayed transfers of care, discharge destination, readmissions, death and dementia through linkage to electronic mental health records.
Results: ORCHARD (2017-2019) includes data from 99,147 consecutive, unselected hospital admissions across all specialties (n=67,585 [68%] inpatient versus n=31,562 [32%] day case; n=73,385 [81%] medical versus n=16,918 [19%] surgical/other). Admissions data were linked to 48,333 unique individuals (n=24,466 [51%] female) with a mean/SD age of 78/10, Index of Multiple Deprivation Decile of 7.6/2.1 and Braden Score of 18.7/3.5 at first admission. Frailty was prevalent, with 15,320 (32%) scoring moderate and 3,233 (7%) high on the Hospital Frailty Risk Score. Complete cognitive screening data are available for 13,102 (67%) unique individuals ≥70 years with inpatient admission.
Conclusion: ORCHARD is a large and rich data resource that will enable studies on the burden and impact of cognitive and physical frailty in-hospital, with relevance to the design and delivery of clinical services and understanding of healthcare resource use hospital-wide and by specialty.
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Very good database that has been set up to help plan future studies and also quality improvement work
Well written and easy to fallow
Well done for all the efforts and hard work this must have entailed.
Ideally all these information oue EHR should be recording and it should automatically be available but I suppose this is a journey that you have started and the database will continue to expand.
Best wishes
ORCHARD database
a very useful and clinically relevent database which would generate any more health infoirmation and help in planning service in future. Population locally are lucky to have a database like that. should be enrolled nationally