Wake Forest University School of Medicine researchers Nicholas M. Pajewski, PhD, and Kathryn E. Callahan, MD, MS, work on frailty assessment and care for older adults was presented at the 2026 Fall CTSA Program Annual Meeting, held September 23–25 in Washington, D.C. The theme, “From Discovery to Impact: Advancing the Translational Pathway,” emphasized how clinical and translational science can benefit patients and communities.
Their poster, “From CTSA Pilot Funding to Health System-Wide Impact: Translating the Electronic Frailty Index (eFI) into Clinical Practice,” shows how an initial Clinical and Translational Science Award (CTSA) pilot investment grew into a scalable approach for identifying frailty and connecting vulnerable older adults with appropriate care and support across the health system.
Frailty is a strong predictor of adverse outcomes in older adults, but traditional assessments can be time-intensive and difficult to scale. To address this challenge, the team developed an electronic frailty index (eFI) that uses routinely collected electronic health record (EHR) data to support earlier identification and proactive care planning.
Supported by a 2017 CTSA Pilot Award, the team developed and validated the eFI before integrating it into the Atrium Health EHR environment in 2019. The tool is now embedded across more than 40 hospitals, helping clinicians connect patients with nurse navigation, pre-anesthesia evaluations, post-skilled nursing facility house calls, tailored medical management, and other targeted services.
The initiative has expanded access, strengthened coordination, supported better outcomes and quality of life, and informed data-driven decisions. Its broader impact includes more than 25 peer-reviewed publications and over $2.2 million in subsequent grant awards from the NIH, the Duke Endowment, Doris Duke Charitable Foundation, and other sources.
Thomas Houston, MD, MPH, FACM, and Kristie Foley, PhD, MS, presented the poster and shared the team’s findings with colleagues across the CTSA consortium.
By turning routinely collected EHR data into actionable clinical insights, the project demonstrates how strategic CTSA investment can move research into practice, strengthen health system integration, and improve care for older adults at scale.