Identifying Care Home Residents in Electronic Health Records - An OpenSAFELY Short Data Report

Schultze, Anna; Bates, Chris; Cockburn, Jonathan; MacKenna, Brian; Nightingale, Emily; Curtis, Helen J; Hulme, William; Morton, Caroline E; Croker, Richard; Bacon, Seb; McDonald, Helen I; Rentsch, Christopher T; Bhaskaran, Krishnan; Mathur, Rohini; Tomlinson, Laurie; Williamson, Elizabeth; Forbes, Harriet; Tazare, John; Grint, Daniel; Walker, Alex J; Inglesby, Peter; DeVito, Nicholas J; Mehrkar, Amir; Hickman, George; Davy, Simon; Ward, Tom; Fisher, Louis; Evans, David; Wing, Kevin; Wong, Angel; McManus, Robert; Parry, John; Hester, Frank; Evans, Stephen; Douglas, Ian; Smeeth, Liam; Eggo, Rosalind M

doi:10.12688/wellcomeopenres.16737.1

Cited by 21 publications

(23 citation statements)

References 17 publications

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“…The method used for identifying care home residents in this analysis — a clinical code as detailed by the national reporting specification — will lead to under-ascertainment. 15 The authors of the current study are launching a programme of work, in collaboration with the UK health data science community, to describe and validate the best methods for identifying current care home residents, to produce a better understanding of their health outcomes.…”

Section: Discussionmentioning

confidence: 99%

Trends and clinical characteristics of COVID-19 vaccine recipients: a federated analysis of 57.9 million patients' primary care records in situ using OpenSAFELY

et al. 2021

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BackgroundOn 8 December 2020 NHS England administered the first COVID-19 vaccination.AimTo describe trends and variation in vaccine coverage in different clinical and demographic groups in the first 100 days of the vaccine rollout.Design and settingWith the approval of NHS England, a cohort study was conducted of 57.9 million patient records in general practice in England, in situ and within the infrastructure of the electronic health record software vendors EMIS and TPP using OpenSAFELY.MethodVaccine coverage across various subgroups of Joint Committee on Vaccination and Immunisation (JCVI) priority cohorts is described.ResultsA total of 20 852 692 patients (36.0%) received a vaccine between 8 December 2020 and 17 March 2021. Of patients aged ≥80 years not in a care home (JCVI group 2) 94.7% received a vaccine, but with substantial variation by ethnicity (White 96.2%, Black 68.3%) and deprivation (least deprived 96.6%, most deprived 90.7%). Patients with pre-existing medical conditions were more likely to be vaccinated with two exceptions: severe mental illness (89.5%) and learning disability (91.4%). There were 275 205 vaccine recipients who were identified as care home residents (JCVI group 1; 91.2% coverage). By 17 March, 1 257 914 (6.0%) recipients had a second dose.ConclusionThe NHS rapidly delivered mass vaccination. In this study a data-monitoring framework was deployed using publicly auditable methods and a secure in situ processing model, using linked but pseudonymised patient-level NHS data for 57.9 million patients. Targeted activity may be needed to address lower vaccination coverage observed among certain key groups.

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Section: Discussionmentioning

confidence: 99%

Trends and clinical characteristics of COVID-19 vaccine recipients: a federated analysis of 57.9 million patients' primary care records in situ using OpenSAFELY

et al. 2021

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“…The main potential weakness of our analysis is that all of the methods available to identify care home residents in UK using electronic healthcare records are subject to limitations. 6 , 17 , 18 We used an address linkage with CQC data. Although this is expected to have a high positive predictive value, 17 , 18 the prevalence of care home residency is approximately a third lower than expected based on estimates from the 2011 census.…”

Section: Discussionmentioning

confidence: 99%

“…The identification of care homes in OpenSAFELY has been previously described. 6 Briefly, the address an individual used to register with their GP was matched to the Care Quality Commission (CQC) registry of public and privately owned old-age care homes. Natural language processing was applied to the addresses to account for spelling inconsistencies, and data cleaning based on the number of residents at a given address was also undertaken.…”

Section: Methodsmentioning

confidence: 99%

“…This resulted in an increase of approximately 25,000 in the number of people classified as care home residents. 6 We did not use this definition in our primary analyses, as GP coded events do not reflect the time-varying nature of care home residency and the accuracy of these codes is not known. We also estimated the monthly probability of individuals being tested for COVID-19 and the probability of being admitted to hospital using linked data from Second Generation Surveillance System (SGSS) dataset and the Secondary Uses Service (SUS) dataset by place of residence (care home or private home).…”

Section: Methodsmentioning

confidence: 99%

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Mortality among Care Home Residents in England during the first and second waves of the COVID-19 pandemic: an observational study of 4.3 million adults over the age of 65

Schultze

Nightingale

Evans

et al. 2022

The Lancet Regional Health - Europe

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Background Residents in care homes have been severely impacted by COVID-19. We describe trends in the mortality risk among residents of care homes compared to private homes. Methods On behalf of NHS England we used OpenSAFELY-TPP to calculate monthly age-standardised risks of death due to all causes and COVID-19 among adults aged >=65 years between 1/2/2019 and 31/03/2021. Care home residents were identified using linkage to Care and Quality Commission data. Findings We included 4,340,648 people aged 65 years or older on the 1st of February 2019, 2.2% of whom were classified as residing in a care or nursing home. Age-standardised mortality risks were approximately 10 times higher among care home residents compared to those in private housing in February 2019: comparative mortality figure (CMF) = 10.59 (95%CI = 9.51, 11.81) among women, and 10.87 (9.93, 11.90) among men. By April 2020 these relative differences had increased to more than 17 times with CMFs of 17.57 (16.43, 18.79) among women and 18.17 (17.22, 19.17) among men. CMFs did not increase during the second wave, despite a rise in the absolute age-standardised COVID-19 mortality risks. Interpretation COVID-19 has had a disproportionate impact on the mortality of care home residents in England compared to older residents of private homes, but only in the first wave. This may be explained by a degree of acquired immunity, improved protective measures or changes in the underlying frailty of the populations. The care home population should be prioritised for measures aimed at controlling COVID-19. Funding Medical Research Council MR/V015737/1

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“…Data were not available for epilepsy, which is a covid-19 risk factor and more common among people with learning disability 1113. We also had an incomplete, and probably underestimated, measure of residential care 1638…”

Section: Discussionmentioning

confidence: 99%

Risks of covid-19 hospital admission and death for people with learning disability: population based cohort study using the OpenSAFELY platform

Williamson

McDonald

Bhaskaran

et al. 2021

BMJ

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Objective To assess the association between learning disability and risk of hospital admission and death from covid-19 in England among adults and children. Design Population based cohort study on behalf of NHS England using the OpenSAFELY platform. Setting Patient level data were obtained for more than 17 million people registered with a general practice in England that uses TPP software. Electronic health records were linked with death data from the Office for National Statistics and hospital admission data from NHS Secondary Uses Service. Participants Adults (aged 16-105 years) and children (<16 years) from two cohorts: wave 1 (registered with a TPP practice as of 1 March 2020 and followed until 31 August 2020); and wave 2 (registered 1 September 2020 and followed until 8 February 2021). The main exposure group consisted of people on a general practice learning disability register; a subgroup was defined as those having profound or severe learning disability. People with Down’s syndrome and cerebral palsy were identified (whether or not they were on the learning disability register). Main outcome measure Covid-19 related hospital admission and covid-19 related death. Non-covid-19 deaths were also explored. Results For wave 1, 14 312 023 adults aged ≥16 years were included, and 90 307 (0.63%) were on the learning disability register. Among adults on the register, 538 (0.6%) had a covid-19 related hospital admission; there were 222 (0.25%) covid-19 related deaths and 602 (0.7%) non-covid deaths. Among adults not on the register, 29 781 (0.2%) had a covid-19 related hospital admission; there were 13 737 (0.1%) covid-19 related deaths and 69 837 (0.5%) non-covid deaths. Wave 1 hazard ratios for adults on the learning disability register (adjusted for age, sex, ethnicity, and geographical location) were 5.3 (95% confidence interval 4.9 to 5.8) for covid-19 related hospital admission and 8.2 (7.2 to 9.4) for covid-19 related death. Wave 2 produced similar estimates. Associations were stronger among those classified as having severe to profound learning disability, and among those in residential care. For both waves, Down’s syndrome and cerebral palsy were associated with increased hazards for both events; Down’s syndrome to a greater extent. Hazard ratios for non-covid deaths followed similar patterns with weaker associations. Similar patterns of increased relative risk were seen for children, but covid-19 related deaths and hospital admissions were rare, reflecting low event rates among children. Conclusions People with learning disability have markedly increased risks of hospital admission and death from covid-19, over and above the risks observed for non-covid causes of death. Prompt access to covid-19 testing and healthcare is warranted for this vulnerable group, and prioritisation for covid-19 vaccination and other targeted preventive measures should be considered.

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Identifying Care Home Residents in Electronic Health Records - An OpenSAFELY Short Data Report

Cited by 21 publications

References 17 publications

Trends and clinical characteristics of COVID-19 vaccine recipients: a federated analysis of 57.9 million patients' primary care records in situ using OpenSAFELY

Trends and clinical characteristics of COVID-19 vaccine recipients: a federated analysis of 57.9 million patients' primary care records in situ using OpenSAFELY

Mortality among Care Home Residents in England during the first and second waves of the COVID-19 pandemic: an observational study of 4.3 million adults over the age of 65

Risks of covid-19 hospital admission and death for people with learning disability: population based cohort study using the OpenSAFELY platform

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