Manual review of electronic medical records as a reference standard for case definition development: a validation study

Williamson, Tyler; Miyagishima, Rebecca; Derochie, Janeen D.; Drummond, Neil

doi:10.9778/cmajo.20170077

Cited by 16 publications

(18 citation statements)

References 10 publications

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“…Sensitivity analyses showed that in the worst scenario, the PPV would be 77.8%. Our PPV estimate was slightly higher than values observed in previous studies that assessed the quality of routinely collected data on dementia in primary-care services for research purposes 10,24,25. When routinely collected electronic health records are applied to research, avoiding false-positive diagnoses could be more important than avoiding false negatives.…”

Section: Discussioncontrasting

confidence: 72%

<p>Epidemiology of dementia: prevalence and incidence estimates using validated electronic health records from primary care</p>

Ponjoan¹,

Garré-Olmo²,

Blanch³

et al. 2019

CLEP

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Purpose: Updated estimates of incidence and prevalence of dementia are crucial to ensure adequate public health policy. However, most of the epidemiological studies in the population in Spain were conducted before 2010. This study assessed the validity of dementia diagnoses recorded in electronic health records contained in a large primary-care database to determine if they could be used for research purposes. Then, to update the epidemiology of dementia in Catalonia (Spain), we estimated crude and standardized prevalence and incidence rates of dementia in Catalonia in 2016. Methods: The System for the Development of Research in Primary Care (SIDIAP) database contains anonymized information for >80% of the Catalan population. Validity of dementia codes in SIDIAP was assessed in patients at least 40 years old by asking general practitioners for additional evidence to support the diagnosis. Crude and standardized incidence and prevalence (95% CI) in people aged ≥65 years were estimated assuming a Poisson distribution. Results: The positive predictive value of dementia diagnoses recorded in SIDIAP was estimated as 91.0% (95% CI 87.5%-94.5%). Age-and sex-standardized incidence and prevalence of dementia were 8.6/1,000 person-years (95% CI 8.0-9.3) and 5.1% (95% CI 4.5%-5.7%), respectively. Conclusion: SIDIAP contains valid dementia records. We observed incidence and prevalence estimations similar to recent face-to-face studies conducted in Spain and higher than studies using electronic health data from other European populations.

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Section: Discussioncontrasting

confidence: 72%

<p>Epidemiology of dementia: prevalence and incidence estimates using validated electronic health records from primary care</p>

Ponjoan¹,

Garré-Olmo²,

Blanch³

et al. 2019

CLEP

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“…Clinical data is organized via the patient's unique health insurance number and is de-identified prior to data transfer to CPCSSN [48]. The CPCSSN data undergoes rigorous quality control procedures and was previously determined to be a valid data source to study eight chronic diseases [54], and a valid proxy (77.5-97.2% sensitivity and 93.1-99.4% specificity) to manual review of electronic chart raw data for validation studies [55].…”

Section: Methods Settingmentioning

confidence: 99%

“…However, similar procedure codes are used in other provincial jurisdictions [89,90] and can be substituted for the NL chronic pain intervention procedure codes. A chronic limitation for all validation studies involving administrative and medical records data is the dependence of its quality on the accuracy of data entry at source [25,38,55].…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Identifying cases of chronic pain using health administrative data: A validation study

Foley

Knight

Ploughman

et al. 2019

Preprint

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Background: Chronic pain is a pervasive and challenging public health issue. Prevalence estimates vary widely, both globally (2-54%) and in Canada (6.5-44%). Most estimates are derived from surveys, which are expensive and labour intensive. Health administrative data is a potential easily-accessed, low-cost method to obtain epidemiological and cost estimates of chronic pain, but its validity as a source to ascertain cases of this complex and multi-faceted condition is unknown. The purpose of this study was to derive and validate an algorithm to identify cases of chronic pain using health administrative data.Methods: A reference standard was developed and applied to the electronic medical records data of a general population sample participating in the Canadian Primary Care Sentinel Surveillance Network. Preliminary chronic pain algorithms were then created and refined through health administrative data analysis of four populations with known chronic pain diagnoses. Classification performance of the chronic pain administrative data algorithms was compared to that of the reference standard, and statistical tests of selection accuracy (sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio positive, likelihood ratio negative, diagnostic odds ratio, Kappa agreement, and area under the Receiver Operating Characteristic curve) were calculated. Results: The optimal algorithm to ascertain cases of chronic pain from health administrative data was a combination of one chronic pain clinic procedure code OR five physician claims with a pain-related diagnostic code in five years with more than 183 days separating at least two claims. The sensitivity was 0.703 (0.684-0.721 95% confidence interval), the specificity was 0.668 (0.657-0.679 95% confidence interval), and the positive predictive value was 0.408(0.398-0.418 95% confidence interval). The Chronic Pain Algorithm identified 37.6% of a Newfoundland and Labrador provincial cohort. Conclusions: Health administrative data is a valid source for information on chronic pain in Canada. The optimal chronic pain algorithm can be used to determine epidemiology and health care utilization statistics on people seeking physician care for chronic pain, and to evaluate cost effectiveness of any change to policy or health service delivery.

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“…In cases where there was uncertainty, the SAPCReN-CPCSSN records were sent to the other three reviewers to assess "caseness" and the majority answer was selected as the decision. The method of using CPCSSN-processed data to identify the set of reference cases has been proven to be an acceptable substitute for raw EMR data 13 .…”

Section: Establishing the Reference Standardmentioning

confidence: 99%

Validating a case definition for adult asthma in primary care electronic medical records

Cave

Soós

Gillies

et al. 2020

npj Prim. Care Respir. Med.

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Although asthma is one of the most common chronic conditions affecting Canadians, its epidemiologic characteristics and burden in primary care contexts are poorly understood. The aim of this study was to develop and validate a case definition to identify adults with asthma who consult family physicians and to estimate the prevalence of asthma in that setting in Canada. This validation study utilized a database of electronic medical records (EMRs) from the Southern Alberta Primary Care Research Network, a node of the Canadian Primary Care Sentinel Surveillance Network (SAPCReN-CPCSSN). The population included patients over age 17y of any gender and health status who had visited an SAPCReN-CPCSSN primary care provider during the period December 1, 2014−December 31, 2016. The validation of the case definition involved comparing a case-finding algorithm to caseness determined by an expert physician review of the records of 1000 patient in the CPCSSN database. The case definition, which included the ICD-9 code 493 and asthma-related text words, had 83.33% sensitivity (95% CI: 63.61-93.88%), 99.28% specificity (95% CI: 98.51-99.67%), a positive predictive value of 74.07% (95% CI: 55.03-87.14%), and a negative predictive value of 99.59% (95% CI: 98.93-99.86%). The prevalence of adult asthma in CPCSSN primary care practices in southern Alberta was 4.20% (95% CI: 4.09-4.31). The strong validation metrics suggest that this case definition is valid for both clinical and research purposes. The validated case definition may be used to improve patient care and improve understanding of the prevalence and burden of asthma in primary care in Canada.

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Manual review of electronic medical records as a reference standard for case definition development: a validation study

Cited by 16 publications

References 10 publications

<p>Epidemiology of dementia: prevalence and incidence estimates using validated electronic health records from primary care</p>

<p>Epidemiology of dementia: prevalence and incidence estimates using validated electronic health records from primary care</p>

Identifying cases of chronic pain using health administrative data: A validation study

Validating a case definition for adult asthma in primary care electronic medical records

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