Do practice characteristics explain differences in morbidity estimates between electronic health record based general practice registration networks?

Dungen, Catharina van den; Hoeymans, Nancy; Akker, Marjan van den; Biermans, M. C. J.; Boven, Kees van; Joosten, Jhk; Verheij, R.A.; Waal, Margot de; Schellevis, F.G.; Oers, Hans van

doi:10.1186/s12875-014-0176-7

Cited by 12 publications

(15 citation statements)

References 10 publications

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“…In the Netherlands, nearly all non-institutionalized inhabitants are registered with a single general practitioner (GP), and morbidity is recorded through EHRs [14]. In 1988, the first national dementia guideline appeared, followed by a primary care guideline 10 y later, both of which have been amended since.…”

Section: Introductionmentioning

confidence: 99%

Dementia incidence trend over 1992-2014 in the Netherlands: Analysis of primary care data

et al. 2017

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BackgroundRecent reports have suggested declining age-specific incidence rates of dementia in high-income countries over time. Improved education and cardiovascular health in early age have been suggested to be bringing about this effect. The aim of this study was to estimate the age-specific dementia incidence trend in primary care records from a large population in the Netherlands.Methods and findingsA dynamic cohort representative of the Dutch population was composed using primary care records from general practice registration networks (GPRNs) across the country. Data regarding dementia incidence were obtained using general-practitioner-recorded diagnosis of dementia within the electronic health records. Age-specific dementia incidence rates were calculated for all persons aged 60 y and over; negative binomial regression analysis was used to estimate the time trend. Nine out of eleven GPRNs provided data on more than 800,000 older people for the years 1992 to 2014, corresponding to over 4 million person-years and 23,186 incident dementia cases. The annual growth in dementia incidence rate was estimated to be 2.1% (95% CI 0.5% to 3.8%), and incidence rates were 1.08 (95% CI 1.04 to 1.13) times higher for women compared to men. Despite their relatively low numbers of person-years, the highest age groups contributed most to the increasing trend. There was no significant overall change in incidence rates since the start of a national dementia program in 2003 (−0.025; 95% CI −0.062 to 0.011). Increased awareness of dementia by patients and doctors in more recent years may have influenced dementia diagnosis by general practitioners in electronic health records, and needs to be taken into account when interpreting the data.ConclusionsWithin the clinical records of a large, representative sample of the Dutch population, we found no evidence for a declining incidence trend of dementia in the Netherlands. This could indicate true stability in incidence rates, or a balance between increased detection and a true reduction. Irrespective of the exact rates and mechanisms underlying these findings, they illustrate that the burden of work for physicians and nurses in general practice associated with newly diagnosed dementia has not been subject to substantial change in the past two decades. Hence, with the ageing of Western societies, we still need to anticipate a dramatic absolute increase in dementia occurrence over the years to come.

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Section: Introductionmentioning

confidence: 99%

Dementia incidence trend over 1992-2014 in the Netherlands: Analysis of primary care data

et al. 2017

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“…We and others [3, 4] looked at differences between registration network within the same country and found large differences that could not be fully explained. When comparing registration-based data between countries, we expected similar differences in the organization of data collection as between networks in the Netherlands.…”

Section: Discussionmentioning

confidence: 86%

“…The same was found for differences between GPs and general practices. Differences in type of practice (solo, duo, or group), mean years of medical experience, and distance to nearest hospital did not explain the variance between the networks [4]. …”

Section: Discussionmentioning

confidence: 99%

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Estimating incidence and prevalence rates of chronic diseases using disease modeling

Boshuizen¹,

Poos²,

Akker³

et al. 2017

Popul Health Metrics

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BackgroundMorbidity estimates between different GP registration networks show large, unexplained variations. This research explores the potential of modeling differences between networks in distinguishing new (incident) cases from existing (prevalent) cases in obtaining more reliable estimates.MethodsData from five Dutch GP registration networks and data on four chronic diseases (chronic obstructive pulmonary disease [COPD], diabetes, heart failure, and osteoarthritis of the knee) were used. A joint model (DisMod model) was fitted using all information on morbidity (incidence and prevalence) and mortality in each network, including a factor for misclassification of prevalent cases as incident cases.ResultsThe observed estimates vary considerably between networks. Using disease modeling including a misclassification term improved the consistency between prevalence and incidence rates, but did not systematically decrease the variation between networks. Osteoarthritis of the knee showed large modeled misclassifications, especially in episode of care-based registries.ConclusionRegistries that code episodes of care rather than disease generally provide lower estimates of the prevalence of chronic diseases requiring low levels of health care such as osteoarthritis. For other diseases, modeling misclassification rates does not systematically decrease the variation between registration networks. Using disease modeling provides insight in the reliability of estimates.

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“…During assessments, demographic characteristics, medication use, smoking habits, and self-reported history of cardiovascular morbidity and T2DM were collected and cross-checked with the electronic medical records (EMRs) of all participants. In the Netherlands, nearly all inhabitants are registered with a GP, 11 and GPs record diagnoses in the EMRs, including those made by specialists after referral. Mean systolic blood pressure (SBP) and diastolic blood pressure were measured using a standardized protocol.…”

Section: Methodsmentioning

confidence: 99%

Effects of Primary Cardiovascular Prevention on Vascular Risk in Older Adults

Bussel

Hoevenaar‐Blom

Busschers

et al. 2018

American Journal of Preventive Medicine

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Multicomponent cardiovascular prevention did not improve the overall risk profile in older adults in a primary prevention setting, relative to usual care. However, exploratory analyses showed an effect on blood pressure and smoking cessation. Possibly, contrast between study groups was too small because of the Hawthorne (being part of a study) effect and increasing quality of (preventive) health care for older adults, to yield an effect on the risk profile.

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Do practice characteristics explain differences in morbidity estimates between electronic health record based general practice registration networks?

Cited by 12 publications

References 10 publications

Dementia incidence trend over 1992-2014 in the Netherlands: Analysis of primary care data

Dementia incidence trend over 1992-2014 in the Netherlands: Analysis of primary care data

Estimating incidence and prevalence rates of chronic diseases using disease modeling

Effects of Primary Cardiovascular Prevention on Vascular Risk in Older Adults

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