NHSE Subsegment / Condition Definitions

A national data-driven approach to population segmentation has been developed to support Population Health Management (PHM) outlined in the NHS Long Term Plan. The subsegment and condition definitions in this section provide further detail on the business rules that have been applied to the data sources.

Read more about the background to segmentation, which includes how the project and the Segmentation Dataset output is delivered as part of this initiative.

Back to PHM and Segmentation

Intermediate Frailty Risk

Segment: Frailty and Dementia

Subsegment Description

All people aged 65 and over who have an intermediate risk for frailty.

Data Definition

All people aged 65 and over who have an intermediate risk for frailty as defined by the Hospital Frailty Risk Score (HFRS)1. HFRS is based on diagnoses recorded during hospital admissions.

Hospital Frailty Risk Score

[Summary extract from OBH Frailty Pilot – Selection of Frailty Identification Tool Report – Dec. 2019]

The Hospital Frailty Risk Score (HFRS) is a risk score calculated based on ICD-10 codes routinely recorded in secondary care data. It was published by Gilbert et al. in the Lancet in 2018 . The authors defined a set of diagnoses as a priori markers of frailty. They then conducted a cluster analysis to identify the ICD-10 codes associated with people aged 75 and over, admitted to hospital, who had high resource use and frailty-associated diagnoses. Only ICD-10 codes identified as being twice as prevalent in the frail cluster were included in the final frailty score.

Each code included in the score was assigned a number of points proportionate to how strongly it predicted membership of the frailty cluster. Points for each diagnosis code an individual has had over a rolling 2 year period are summed to create their final score. Scores are divided (based on a pragmatic split) into low risk <5, intermediate risk 5-15 and high risk >15.

1Gilbert T, et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. 2018. V. 391, I. 10132, p1775-1782.

Data Sources Used

Diagram showing that the dataset SUS (APC & OP) is used in the Intermediate Frailty Risk subsegment.

For more information about each of the data sources click here

Severe Frailty Risk

Segment: Frailty and Dementia

Subsegment Description

All people aged 65 and over who have a severe risk for frailty.

Data Definition

All people aged 65 and over who have a severe risk for frailty as defined by the Hospital Frailty Risk Score (HFRS)1. The HFRS is based on diagnoses recorded during hospital admissions.

Hospital Frailty Risk Score

[Summary extract from OBH Frailty Pilot – Selection of Frailty Identification Tool Report – Dec. 2019]

The Hospital Frailty Risk Score (HFRS) is a risk score calculated based on ICD-10 codes routinely recorded in secondary care data. It was published by Gilbert et al. in the Lancet in 2018 . The authors defined a set of diagnoses as a priori markers of frailty. They then conducted a cluster analysis to identify the ICD-10 codes associated with people aged 75 and over, admitted to hospital, who had high resource use and frailty-associated diagnoses. Only ICD-10 codes identified as being twice as prevalent in the frail cluster were included in the final frailty score.

Each code included in the score was assigned a number of points proportionate to how strongly it predicted membership of the frailty cluster. Points for each diagnosis code an individual has had over a rolling 2 year period are summed to create their final score. Scores are divided (based on a pragmatic split) into low risk <5, intermediate risk 5-15 and high risk >15.

1Gilbert T, et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. 2018. V. 391, I. 10132, p1775-1782.

Data Sources Used

Diagram showing that the dataset SUS (APC & OP) is used in the Severe Frailty Risk subsegment.

For more information about each of the data sources click here

Dementia

Segment: Frailty and Dementia

Subsegment Description

All people who have a diagnosis of dementia.

Data Definition

All people with dementia recorded during:

  • a hospital admission (recorded either as the reason for admission or as a co-
    morbidity),
  • an outpatient appointment,
  • an A&E attendance, or
  • a mental health services appointment or admission, including for ‘Improving Access to Psychological Therapies’ services

Number of Clinical Codes Used

  • 26 ICD-10 diagnosis codes
  • 1 SNOMED diagnosis code (applied to ECDS only)
  • 4 Care Cluster codes

Data Sources Used

Diagram showing that the datasets SUS (APC & OP), SUS Data (ECDS), and Mental Health Data (Inc IAPT, are used in the Dementia subsegment.

For more information about each of the data sources click here