Electronic Health Record Use to Classify Patients with Newly Diagnosed versus Preexisting Type 2 Diabetes: Infrastructure for Comparative Effectiveness Research and Population Health Management
- 1 February 2012
- journal article
- research article
- Published by Mary Ann Liebert Inc in Population Health Management
- Vol. 15 (1), 3-11
- https://doi.org/10.1089/pop.2010.0084
Abstract
Use of electronic health record (EHR) content for comparative effectiveness research (CER) and population health management requires significant data configuration. A retrospective cohort study was conducted using patients with diabetes followed longitudinally (N = 36,353) in the EHR deployed at outpatient practice networks of 2 health care systems. A data extraction and classification algorithm targeting identification of patients with a new diagnosis of type 2 diabetes mellitus (T2DM) was applied, with the main criterion being a minimum 30-day window between the first visit documented in the EHR and the entry of T2DM on the EHR problem list. Chart reviews (N = 144) validated the performance of refining this EHR classification algorithm with external administrative data. Extraction using EHR data alone designated 3205 patients as newly diagnosed with T2DM with classification accuracy of 70.1%. Use of external administrative data on that preselected population improved classification accuracy of cases identified as new T2DM diagnosis (positive predictive value was 91.9% with that step). Laboratory and medication data did not help case classification. The final cohort using this 2-stage classification process comprised 1972 patients with a new diagnosis of T2DM. Data use from current EHR systems for CER and disease management mandates substantial tailoring. Quality between EHR clinical data generated in daily care and that required for population health research varies. As evidenced by this process for classification of newly diagnosed T2DM cases, validation of EHR data with external sources can be a valuable step. (Population Health Management 2012;15:3–11)Keywords
This publication has 11 references indexed in Scilit:
- Executive Summary: Standards of Medical Care in Diabetes—2010Diabetes Care, 2010
- Identifying primary care patients at risk for future diabetes and cardiovascular disease using electronic health recordsBMC Health Services Research, 2009
- An Electronic Practice-Based Network for Observational Comparative Effectiveness ResearchAnnals of Internal Medicine, 2009
- Results of a retrospective, observational pilot study using electronic medical records to assess the prevalence and characteristics of patients with resistant hypertension in an ambulatory care settingClinical Therapeutics, 2009
- Reflections on the use of electronic health record data for clinical researchHealth Informatics Journal, 2009
- Computerized Extraction of Information on the Quality of Diabetes Care from Free Text in Electronic Patient Records of General PractitionersJournal of the American Medical Informatics Association, 2007
- Use of an Electronic Medical Record for the Identification of Research Subjects with Diabetes MellitusClinical Medicine & Research, 2007
- Comparison of Methodologies for Calculating Quality Measures Based on Administrative Data versus Clinical Data from an Electronic Health Record System: Implications for Performance MeasuresJournal of the American Medical Informatics Association, 2007
- Validity of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Acute Renal FailureJournal of the American Society of Nephrology, 2006
- Characteristics of an Adult Population With Newly Diagnosed Type 2 DiabetesDiabetes Care, 2001