ClinicalCodes: An Online Clinical Codes Repository to Improve the Validity and Reproducibility of Research Using Electronic Medical Records

Springate, David A.; Kontopantelis, Evangelos; Ashcroft, Darren M.; Olier, Iván; Parisi, Rosa; Edmore, Chamapiwa; Reeves, David

doi:10.1371/journal.pone.0099825

Cited by 162 publications

(202 citation statements)

References 29 publications

(37 reference statements)

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“…The READ codes used in this study are available from the Clinical Codes repository (www. clinicalcodes.org) [24]. We examined the electronic health records of the included individuals to determine the presence of foot ulcers occurring after 1 January 2004 using the relevant READ codes.…”

Section: Methodsmentioning

confidence: 99%

Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort

et al. 2017

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Aims/hypothesis The aim of this study was to determine whether social deprivation in the presence of diabetes is an independent predictor of developing a foot ulcer and separately of mortality. Methods This was a primary-care-based retrospective analysis of 13,955 adults with type 1 (n = 1370) or type 2 (n = 12,585) diabetes after a median follow-up of 10.5 years. Demographic characteristics, indices of social deprivation and clinical variables were assessed at baseline. The primary outcomes were new foot ulceration (in those without a previous history of foot ulcers) and all-cause mortality. Cox proportional hazard models were used to describe the associations among foot ulceration, social deprivation and mortality. Results The mean age of the population was 69.4 (range: 16-89) years. The incidence of foot ulceration was greater in individuals with type 2 (8.6%) compared with type 1 diabetes (4.8%). Occurrence was similar by sex, but increased with age and deprivation index. Individuals in the highest quintile of deprivation were 77% more likely to develop a foot ulcer compared with those in the lowest quintile (OR 1.77 [95% CI 1.45, 2.14], p < 0.0001). Overall, 2946 (21.1%) deaths were recorded. Compared with individuals without a foot ulcer, the development of a foot ulcer was associated with a higher age-and sex-adjusted mortality rate (25.9% vs 14.0%), and a 72% (HR Conclusions/interpretation This study confirms the high mortality rate in individuals with diabetes-related foot ulcers. In addition, socioeconomic disadvantage was found to be an independent effect modifier, contributing to an increased burden of mortality in people with diabetes who develop foot ulceration. In light of this, and as diabetes service configurations are orientated for the next 5-10 years, modelling of foot ulceration risk needs to take socioeconomic disadvantage into account.

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Section: Methodsmentioning

confidence: 99%

Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort

et al. 2017

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“…27 Another UK based study of primary care data from The Health Improvement Network (THIN) found that the intentional incidence of poisoning in females aged 15-17 years increased from 39.1 to 46.6 per 10 000 person years between the two successive calendar periods, 1992-96 to 2007-12. 25 Recent data from the adult psychiatric morbidity survey in England, 28 based on clinical interviews, indicate that 11.7% of [16][17][18][19][20][21][22][23][24] year old females in 2007 reported ever self harming, increasing to 19.7% in 2014. In a multicentre hospital based study in England, 26 age standardised incidence of self harm appeared to decline from 2000 until 2009, with a possible increase and stabilising of rates from 2009 to 2012, although figures were based on a combined age range of 15-24 years.…”

Section: Temporal Trends In Sex and Age Specific Incidencementioning

confidence: 99%

Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

Morgan

Webb

Carr

et al. 2017

BMJ

Self Cite

283

272

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Objectives To examine temporal trends in sex and age specific incidence of self harm in children and adolescents, clinical management patterns, and risk of cause specific mortality following an index self harm episode at a young age. Design Population based cohort study. Setting UK Clinical Practice Research Datalink—electronic health records from 674 general practices, with practice level deprivation measured ecologically using the index of multiple deprivation. Patients from eligible English practices were linked to hospital episode statistics (HES) and Office for National Statistics (ONS) mortality records. Participants For the descriptive analytical phases we examined data pertaining to 16 912 patients aged 10-19 who harmed themselves during 2001-14. For analysis of cause specific mortality following self harm, 8638 patients eligible for HES and ONS linkage were matched by age, sex, and general practice with up to 20 unaffected children and adolescents (n=170 274). Main outcome measures In the first phase, temporal trends in sex and age specific annual incidence were examined. In the second phase, clinical management was assessed according to the likelihood of referral to mental health services and psychotropic drug prescribing. In the third phase, relative risks of all cause mortality, unnatural death (including suicide and accidental death), and fatal acute alcohol or drug poisoning were estimated as hazard ratios derived from stratified Cox proportional hazards models for the self harm cohort versus the matched unaffected comparison cohort. Results The annual incidence of self harm was observed to increase in girls (37.4 per 10 000) compared with boys (12.3 per 10 000), and a sharp 68% increase occurred among girls aged 13-16, from 45.9 per 10 000 in 2011 to 77.0 per 10 000 in 2014. Referrals within 12 months of the index self harm episode were 23% less likely for young patients registered at the most socially deprived practices, even though incidences were considerably higher in these localities. Children and adolescents who harmed themselves were approximately nine times more likely to die unnaturally during follow-up, with especially noticeable increases in risks of suicide (deprivation adjusted hazard ratio 17.5, 95% confidence interval 7.6 to 40.5) and fatal acute alcohol or drug poisoning (34.3, 10.2 to 115.7). Conclusions Gaining a better understanding of the mechanisms responsible for the recent apparent increase in the incidence of self harm among early-mid teenage girls, and coordinated initiatives to tackle health inequalities in the provision of services to distressed children and adolescents, represent urgent priorities for multiple public agencies.

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“…We included age, sex, number of general practitioner consultations, and having had a previous emergency hospital admission in 2010-2012. We also included the following morbidities measured before April 2012 (presence of each diagnosis was ascertained using published clinical code lists as collected in the Manchester Clinical Codes repository 27 ): epilepsy, 28 chronic renal disease, 29 cancer, 30 asthma, 29 stroke, 31 coronary heart disease, 31 diabetes, 31 chronic obstructive pulmonary disease, 28 depression, 32 and schizophrenia. 32 Furthermore, we took into account clustering at the practice level 33 : we included practice-level information including deprivation, location (conurbation, urban, rural), and estimated the number of general practitioners in a practice ascertained from consultations and staff role information.…”

Section: Measures Of Confounding Variablesmentioning

confidence: 99%

Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England

et al. 2017

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PURPOSE Secondary health care services have been under considerable pressure in England as attendance rates increase, resulting in longer waiting times and greater demands on staff. This study's aim was to examine the association between continuity of care and risk of emergency hospital admission among older adults. METHODSWe analyzed records from 10,000 patients aged 65 years and older in 2012 within 297 English general practices obtained from the Clinical Practice Research Datalink and linked with Hospital Episode Statistics. We used the Bice and Boxerman (BB) index and the appointed general practitioner index (last general practitioner consulted before hospitalization) to quantify patient-physician continuity. The BB index was used in a prospective cohort approach to assess impact of continuity on risk of admission. Both indices were used in a separate retrospective nested case-control approach to test the effect of changing physician on the odds of hospital admission in the following 30 days. RESULTSIn the prospective cohort analysis, the BB index showed a graded, nonsignificant inverse relationship of continuity of care with risk of emergency hospital admission, although the hazard ratio for patients experiencing least continuity was 2.27 (95% CI, 1.37-3.76) compared with those having complete continuity. In the retrospective nested case-control analysis, we found a graded inverse relationship between continuity of care and emergency hospital admission for both BB and appointed general practitioner indices: for the latter, the odds ratio for those experiencing least continuity was 2.32 (95% CI, 1.48-3.63) relative to those experiencing most continuity.CONCLUSIONS Marked discontinuity of care might contribute to increased unplanned hospital admissions among patients aged 65 years and older. Schemes to enhance continuity of care have the potential to reduce hospital admissions. 2017;15:515-522. https://doi Ann Fam Med

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ClinicalCodes: An Online Clinical Codes Repository to Improve the Validity and Reproducibility of Research Using Electronic Medical Records

Cited by 162 publications

References 29 publications

Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort

Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort

Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England

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