Frailty Management Solutions

Proactively assess, monitor and manage frail individuals with Graphnet’s Frailty Management Solution.

Our innovative system supports care teams across the care community to collaboratively create, view, and update plans, assessments, contacts, and other critical information in real time.

Key Features of the Frailty Management System

Access Frailty Status Information: View existing frailty data provided by primary care providers.
Conduct In-Depth Assessments: Perform evaluations on cognition, falls, nutrition, function, skin health and overall well-being.
Record Vital Signs and Observations: Quickly capture and update essential health metrics.
Develop Integrated Care Plans: Link seamlessly to areas within the Shared Care Record to create Care and Support Plans that include personal details, goal tracking, contingency planning and End-of-Life records where appropriate.
Include Lifestyle and Environmental Details: Enhance care records with information about a patient’s living conditions and habits.
Manage MDT Actions: Document and track outcomes and decisions from Multi-Disciplinary Team (MDT) meetings.

Key Benefits of Frailty Management

Graphnet’s Frailty Management Solution enhances care delivery with its unified platform, encouraging care teams to work more efficiently and collaboratively.

Its key benefits include:

A Holistic View: Authorised users can access comprehensive frailty data, combining primary care contributions with additional details recorded directly in the Shared Care Record as well as acute data taken from A&E, outpatient and admitted patient care activity .
Real-Time Collaboration: With a shared platform, care teams across disciplines can work together seamlessly, improving communication and care delivery.

The Frailty Dashboard

The Frailty Dashboard provides actionable insights into patient data, helping care teams identify and support individuals with frailty conditions.

Key features include:

Comprehensive Demographics: Gain a clear understanding of patient profiles, including age, gender and location.
Validated Frailty Metrics: Leverage tools like the Electronic Frailty Index and Rockwood Scores to assess the severity of frailty.
Comorbidity Insights: Identify additional health conditions impacting patient care.
Service Utilisation Overview: Track healthcare encounters, including A&E visits and outpatient care to monitor care patterns.
Clinical Data: Access physiological measures, prescribing history and diagnostic results to inform decision making.
Risk Stratification: Utilise Johns Hopkins risk models for proactive care planning.
Customisable Patient Filters: Users can refine data to focus on the most relevant patients and care priorities.

Empower your care teams with the tools they need to deliver effective, tailored support for frail individuals.

Frailty Dashboard

To support people with frailty conditions, this dashboard provides insight on patients utilising the following criteria:

General demographics
Electronic Frailty Index (eFI)
Rockwood score
Comorbidities
Use of services
Physiological measures, prescribing and diagnostics
Johns Hopkins risk stratification

The Graphnet frailty dashboard uses primary care data sources, including clinical tests, prescriptions and encounter activities, as well as acute data sources (for example: A&E, outpatient and admitted patient care activity).

The dashboard defaults to patients aged 65 and over as this is the cohort with the increased likelihood of frailty conditions, however filters will allow users to view patients beyond these age groups. Other filters within the dashboard also provide users with the ability to refine data to the cohorts most relevant to them.