Identifying patients with ischaemic heart disease in general practice: cross sectional study of paper and computerised medical records
Identifying patients with ischaemic heart disease in general practice: cross sectional study of paper and computerised medical records
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DOI：
10.1136/bmj.321.7260.548
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发表时间：
2000-09-02
影响因子：
105.7
通讯作者：
Rowlands, G
中科院分区：
文献类型：
--
作者：
Gray, J;Majeed, A;Rowlands, G
目标 通过使用练习计算机来识别缺血性心脏病患者，并估计所需的工作量。设计横断面研究。 1680 名患者的笔记和计算机记录中的数据被用来建立数据库。用于比较识别缺血性心脏病患者的不同方法。在伦敦南部的巴特西初级保健小组中设置 11 种常规做法。受试者为 40 名 45 岁或以上患者的随机样本中的 1 名。主要结果指标确定为缺血性心脏病的患者数量。结果 缺血性心脏病读取代码 (G3) 与硝酸盐处方的组合具有 73% 的敏感性和产率（100/阳性预测值）每审查 1.2 组笔记，就有 1 例缺血性心脏病。通过搜索同时接受阿司匹林、阿替洛尔、地高辛或他汀类药物治疗的患者的记录，敏感性提高到 96%，但得率下降到三分之一。 结论 虽然计算机搜索 G3 代码或硝酸盐常用于识别病例，但它漏掉了近 30% 的缺血性心脏病患者。通过在搜索策略中添加其他药物，可以识别出更高比例的患者。
Objectives To identify patients with ischaemic heart disease by using a practice computer and to estimate the work required to do so.Design Cross sectional study. Data from the notes and from the computer records of 1680 patients were used to build a database. This was used to compare different methods of identifying patients with ischaemic heart disease.Setting 11 general practices in the Battersea primary care group in south London.Subjects 1 in 40 random sample of patients aged 45 or older.Main outcome measures Numbers of patients identified with ischaemic heart disease.Results The combination of the Read code for ischaemic heart disease (G3) and a prescription for a nitrate had a 73% sensitivity and a yield (100/positive predictive value) of one case of ischaemic heart disease for every 1.2 sets of notes reviewed. By searching the records of patients also receiving aspirin, atenolol, digoxin, or a statin, the sensitivity was increased to 96% but the yield fell to one in three.Conclusion Although commonly used to identify cases, a computer search for G3 code or nitrate missed almost 30% of patients with ischaemic heart disease. A substantially higher percentage of patients can be identified by adding other drugs to the search strategy.