Validation of chronic obstructive pulmonary disease recording in the Clinical Practice Research Datalink (CPRD-GOLD)

Abstract

ObjectivesThe optimal method of identifying people with chronic obstructive pulmonary disease (COPD) from electronic primary care records is not known. We assessed the accuracy of different approaches using the Clinical Practice Research Datalink, a UK electronic health record database.Setting951 participants registered with a CPRD practice in the UK between 1 January 2004 and 31 December 2012. Individuals were selected for ≥1 of 8 algorithms to identify people with COPD. General practitioners were sent a brief questionnaire and additional evidence to support a COPD diagnosis was requested. All information received was reviewed independently by two respiratory physicians whose opinion was taken as the gold standard.Primary outcome measureThe primary measure of accuracy was the positive predictive value (PPV), the proportion of people identified by each algorithm for whom COPD was confirmed.Results951 questionnaires were sent and 738 (78%) returned. After quality control, 696 (73.2%) patients were included in the final analysis. All four algorithms including a specific COPD diagnostic code performed well. Using a diagnostic code alone, the PPV was 86.5% (77.5–92.3%) while requiring a diagnosis plus spirometry plus specific medication; the PPV was slightly higher at 89.4% (80.7–94.5%) but reduced case numbers by 10%. Algorithms without specific diagnostic codes had low PPVs (range 12.2–44.4%).ConclusionsPatients with COPD can be accurately identified from UK primary care records using specific diagnostic codes. Requiring spirometry or COPD medications only marginally improved accuracy. The high accuracy applies since the introduction of an incentivised disease register for COPD as part of Quality and Outcomes Framework in 2004.

Effectiveness and cost-effectiveness of serum B-type natriuretic peptide testing and monitoring in patients with heart failure in primary and secondary care: an evidence synthesis, cohort study and cost-effectiveness model

“…by requesting additional data from GPs for a subset of patients), results for the SA did not find differences between the algorithms with intermediate (2) and least sensitivity (3). Similar findings have been reported in other studies using CPRD data to identify different conditions, [100][101][102] which suggests that CPRD Read Codes can be used to identify a representative sample of patients with a particular condition in the UK. Our study was conducted and reported in accordance with recent guidelines for studies conducted using observational routinely collected health data (REporting of studies Conducted using Observational Routinely collected health Data, RECORD guidelines 103 ), which recognise the additional challenges of conducting research using routinely collected data obtained for administrative and clinical purposes rather than research.…”

The Prevalence of Chronic Obstructive Pulmonary Disease by the Global Lung Initiative Equations in North-Western Russia

“…Only one cough-related and one dyspnoea-related item significantly predicted COPD in a multivariate analysis [44]. Another study showed that the PPV was 12.2% when using only respiratory symptoms, but 43.5% when using symptoms with spirometry [45]. …”

“…The diagnostic value of clinical signs and symptoms for COPD is still contested [44,45]. Price et al [44] have reported on a simple self-administered patient questionnaire that could be used to identify patients exhibiting a high likelihood of COPD for whom spirometry testing would be important.…”

Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD

“…People over the age of 35 who had a GP recorded diagnosis of COPD using a validated definition 14 and did not have alpha one antitrypsin deficiency but had at least one year of historical data before the study start were included. People were deemed eligible for pulmonary rehabilitation if they had a pulmonary rehabilitation code which suggested they were eligible (see Appendix for code list), or if they had an MRC score of 3 or more, or if they had 2 or more GP treated AECOPD in a year or one hospital admission for an AECOPD in a year.…”