Development of a Common Data Model for a Multisite and Multiyear Study of Virtual Visit Implementation

Abstract

Background/Objective: In multisite studies, a common data model (CDM) standardizes dataset organization, variable definitions, and variable code structures and can support distributed data processing. We describe the development of a CDM for a study of virtual visit implementation in 3 Kaiser Permanente (KP) regions. Methods: We conducted several scoping reviews to inform our study’s CDM design: (1) virtual visit mode, implementation timing, and scope (targeted clinical conditions and departments); and (2) extant sources of electronic health record data to specify study measures. Our study covered the period from 2017 through June 2021. Integrity of the CDM was assessed by a chart review of random samples of virtual and in-person visits, overall and by specific conditions of interest (neck or back pain, urinary tract infection, major depression). Results: The scoping reviews identified a need to address differences in virtual visit programs across the 3 KP regionsto harmonize measurement specifications for our research analyses. The final CDM contained patient-level, provider-level, and system-level measures on 7,476,604 person-years for KP members aged 19 years and above. Utilization included 2,966,112 virtual visits (synchronous chats, telephone visits, video visits) and 10,004,195 in-person visits. Chart review indicated the CDM correctly identified visit mode on>96% (n=444) of visits, and presenting diagnosis on >91% (n=482) of visits. Conclusions: Upfront design and implementation of CDMs may be resource intensive. Once implemented, CDMs, like the one we developed for our study, provide downstream programming and analytic efficiencies by harmonizing, in a consistent framework, otherwise idiosyncratic temporal and study site differences in source data.

Management of Neck or Back Pain in Ambulatory Care

“…This approach allowed us to evaluate separately physician ordering behavior from patient adherence behavior, which has heretofore been confounded in studies of ancillary services "utilization". [36][37][38][39][40] Our primary finding is that disruption in co-location of physician and patient during virtual versus in-person visits for incident NBP was associated with different patterns of the physician's ordering of ancillary services for NBP diagnosis and treatment. Physician orders for ancillary services were much less likely for visits delivered virtually versus those delivered in-person.…”

“…We evaluated the association of ancillary services orders and order fulfillment with visit modes and COVID-19 pandemic periods for adults presenting with incident NBP. This approach allowed us to evaluate separately physician ordering behavior from patient adherence behavior, which has heretofore been confounded in studies of ancillary services “utilization” 36–40…”

“…Eligible participants were identified from our study’s common data model (CDM) implemented at 3 KP Regions: Kaiser Permanente Colorado (KPCO), Georgia (KPGA), and Mid-Atlantic States (KPMAS). All 3 KP Regions are primarily group-model integrated delivery systems but differ in important patient population demographic characteristics and mode and timing of virtual visit implementation 39–41…”

“…The samples of patients with incident NBP visits for 2016-June 2021, visit modes and pandemic phases, and classes of ancillary services associated with incident NBP visits were extracted from each site's identically configured CDM using distributed programming code. 39…”

“…All 3 KP Regions are primarily group-model integrated delivery systems but differ in important patient population demographic characteristics and mode and timing of virtual visit implementation. [39][40][41] Under a ceding arrangement, the IRBs of KPCO, KPGA, and KPMAS collectively reviewed and approved the study protocol.…”