Using Electronic Health Records in Longitudinal Studies Estimating Patient Attrition
Using Electronic Health Records in Longitudinal Studies Estimating Patient Attrition
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DOI：
10.1097/mlr.0000000000001298
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发表时间：
2020-06-01
期刊：
影响因子：
3
通讯作者：
Marino, Miguel
中科院分区：
文献类型：
--
作者：
Huguet, Nathalie;Kaufmann, Jorge;Marino, Miguel
背景资料：电子健康记录（EHR）提供了许多领域的丰富数据，这些数据通常在其他数据中不可用，因此，它们是使用纵向研究设计（例如，队列研究，自然实验等）研究健康结果变化的有希望的来源。然而，这些数据中的患者流失率尚不清楚。目的：本研究的目的是评估总体和成年糖尿病或高血压患者：（1）社区卫生中心3年内的患者流失;（2）医疗补助患者永久转换初级保健来源的可能性。研究设计：一项回顾性队列研究使用了来自全国社区卫生中心网络（ADVANCE）临床数据研究网络的2012-2017年数据，以评估EHR数据损耗。俄勒冈州医疗补助登记和索赔数据被用来估计改变初级保健来源的可能性。受试者：来自20个州的76个社区卫生中心系统的827，657名年龄在19-64岁之间的患者，接受了≥ 1次门诊访视。总共有232,891名俄勒冈州医疗补助计划的登记者（年龄在19-64岁之间），在向初级保健来源提出就诊要求后，间隔时间>= 6个月。指标：在合格访视后3年内未返回的患者百分比（流失）。医疗补助患者永久改变其初级保健来源的概率。结果：3年的平均离职率为33.5%，离职率较低（
Background: Electronic health records (EHRs) provide rich data on many domains not routinely available in other data, as such, they are a promising source to study changes in health outcomes using longitudinal study designs (eg, cohort studies, natural experiments, etc.). Yet, patient attrition rates in these data are unknown. Objective: The objective of this study was to estimate overall and among adults with diabetes or hypertension: (1) patient attrition over a 3-year period at community health centers; and (2) the likelihood that patients with Medicaid permanently switched their source of primary care. Research Design: A retrospective cohort study of 2012-2017 data from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Data Research Network of community health centers were used to assess EHR data attrition. Oregon Medicaid enrollment and claims data were used to estimate the likelihood of changing the source of primary care. Subjects: A total of 827,657 patients aged 19-64 with >= 1 ambulatory visit from 76 community health center systems across 20 states. In all, 232,891 Oregon Medicaid enrollees (aged 19-64) with a gap of >= 6 months following a claim for a visit billed to a primary care source. Measures: Percentage of patients not returning within 3 years of their qualifying visit (attrition). The probability that a patient with Medicaid permanently changed their primary care source. Results: Attrition over the 3 years averaged 33.5%; attrition rates were lower (