Validating the 8 CPCSSN Case Definitions for Chronic Disease Surveillance in a Primary Care Database of Electronic Health Records

Abstract

PURPOSEThe Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is Canada's first national chronic disease surveillance system based on electronic health record (EHR) data. The purpose of this study was to develop and validate case definitions and case-finding algorithms used to identify 8 common chronic conditions in primary care: chronic obstructive pulmonary disease (COPD), dementia, depression, diabetes, hypertension, osteoarthritis, parkinsonism, and epilepsy. METHODSUsing a cross-sectional data validation study design, regional and local CPCSSN networks from British Columbia, Alberta (2), Ontario, Nova Scotia, and Newfoundland participated in validating EHR case-finding algorithms. A random sample of EHR charts were reviewed, oversampling for patients older than 60 years and for those with epilepsy or parkinsonism. Charts were reviewed by trained research assistants and residents who were blinded to the algorithmic diagnosis. Sensitivity, specificity, and positive and negative predictive values (PPVs, NPVs) were calculated. RESULTSWe obtained data from 1,920 charts from 4 different EHR systems (Wolf, Med Access, Nightingale, and PS Suite). For the total sample, sensitivity ranged from 78% (osteoarthritis) to more than 95% (diabetes, epilepsy, and parkinsonism); specificity was greater than 94% for all diseases; PPV ranged from 72% (dementia) to 93% (hypertension); NPV ranged from 86% (hypertension) to greater than 99% (diabetes, dementia, epilepsy, and parkinsonism). CONCLUSIONSThe CPCSSN diagnostic algorithms showed excellent sensitivity and specificity for hypertension, diabetes, epilepsy, and parkinsonism and acceptable values for the other conditions. CPCSSN data are appropriate for use in public health surveillance, primary care, and health services research, as well as to inform policy for these diseases.

Use of Direct Oral Anticoagulants in Canadian Primary Care Practice 2010–2015: A Cohort Study From the Canadian Primary Care Sentinel Surveillance Network

“…Canadian Primary Care Sentinel Surveillance Network case definitions were used for hypertension, diabetes mellitus, and dementia 6. Non‐ASA antiplatelet agents include clopidogrel, ticlopidine, dipyridamole, and ticagrelor.…”

“…Using previously standardized and validated case definitions, we also extracted patient‐level comorbidity data from the CPCSSN EMR indicating the presence of chronic obstructive pulmonary disease, depression, diabetes mellitus, hypertension, osteoarthritis, epilepsy, dementia, and Parkinson disease (hereafter called CPCSSN comorbidities ) 6. We also included data from the health conditions and billing tables in each patient's EMR to assess the presence of other diagnoses of interest (ie, cerebrovascular disease, peripheral arterial disease, heart failure, coronary artery disease, chronic kidney disease) and classified these as non‐CPCSSN comorbidities .…”

Prevalence and management of osteoarthritis in primary care: an epidemiologic cohort study from the Canadian Primary Care Sentinel Surveillance Network

“…We have developed validated case definitions for 8 chronic conditions, including the diagnosis of osteoarthritis, which takes into account prescribed medications, billing codes, laboratory tests and multiple diagnostic codes from the International Classification of Diseases, 9th revision (clinical modification) (ICD-9) to find cases. 15,16 CPCSSN is a primary care network comprising 11 practicebased research networks in 7 Canadian provinces and 1 territory. The network extracts patient data from 12 different EMR vendor products.…”

Using Canadian Primary Care Sentinel Surveillance Network data to examine depression in patients with a diagnosis of Parkinson disease: a retrospective cohort study

“…23 The previously validated case definition for Parkinson disease was used and included paralysis agitans and parkinsonism. 23 Tremor, Wolf-Parkinson-White syndrome and "suspected" or "possible" variants were excluded.…”