Improving care for older patients living with frailty: a collaborative approach to creating the DANFRAIL quality database

BACKGROUND: Older patients living with frailty are particularly vulnerable to adverse outcomes during hospitalization and transitions in care. Comprehensive Geriatric Assessment (CGA) has been shown to improve outcomes for these patients. To address the increasing demand for geriatric methodology and improve care quality, the nationwide quality database DANFRAIL was established with a cross-sectoral and interdisciplinary focus, first of its kind worldwide. METHODS: DANFRAIL aims to monitor and enhance quality of care for older patients with frailty across healthcare settings in Denmark. Thus, development involved a co-creation process with expert clinicians and patient representatives from all sectors, guided by a specialist team from the Danish Healthcare Quality Institute. The indicator set, derived from CGA domains, was refined through consensus meetings and public consultation. RESULTS: The initial indicator set includes 6 process indicators and 2 result indicators, focusing on key aspects of care for older patients living with frailty. The public consultation revealed concerns about implementation, workload, registration requirements, and data integration across sectors. Adjustments were made to address these issues and ensure the feasibility of data collection and use. CONCLUSION: DANFRAIL represents a significant step towards improving the quality of care for older patients living with frailty in Denmark. Grounded in the principles of CGA, the database offers a structured, data-driven framework to monitor and enhance care delivery across sectors. By supporting continuous quality improvement and better health outcomes, DANFRAIL sets a national standard for caring for older people in vulnerable situations and may serve as an exemplary approach for international adoption.