Investigating concordance in diabetes diagnosis between primary care charts (electronic medical records) and health administrative data: a retrospective cohort study.
Investigating concordance in diabetes diagnosis between primary care charts (electronic medical records) and health administrative data: a retrospective cohort study.
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DOI：
10.1186/1472-6963-10-347
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发表时间：
2010-12-23
影响因子：
2.8
通讯作者：
Thind A
中科院分区：
文献类型：
--
作者：
Harris SB;Glazier RH;Tompkins JW;Wilton AS;Chevendra V;Stewart MA;Thind A
电子医疗记录包含其他地方不容易获得的有价值的临床信息。因此，它们在促进和加强慢性病登记方面具有重要的潜力，目的是改善慢性病管理;然而，糖尿病等疾病的诊断标准仍有待制定。本研究的目的是建立一个有效的糖尿病电子病历定义。我们使用来自临床评估科学研究所安大略糖尿病数据库的健康管理数据与来自提供初级医疗保健信息项目的电子病历（使用2006年4月1日至2008年3月31日的数据）（N = 19，443）构建了一个回顾性队列。我们系统地检查了糖尿病诊断的八个定义，包括已建立的和提出的。确定糖尿病患者数量最多（N = 2，180）但限于糖尿病概率最高的患者的定义为：≥2次血糖检查异常、或糖尿病问题列表、或胰岛素处方、或≥2种口服降糖药、或HbA 1c ≥ 6.5%的个体。与安大略糖尿病数据库相比，该定义识别了13%以上的患者，同时保持了良好的敏感性（75%）和特异性（98%）。本研究确立了开发糖尿病电子病历标准定义的可行性，并验证了在此背景下使用的算法。虽然该算法可能需要量身定制，以适应不同电子病历中的可用数据，但它有助于建立经过验证的疾病登记处，目的是加强研究，并提高临床护理和患者自我管理的质量。
Electronic medical records contain valuable clinical information not readily available elsewhere. Accordingly, they hold important potential for contributing to and enhancing chronic disease registries with the goal of improving chronic disease management; however a standard for diagnoses of conditions such as diabetes remains to be developed. The purpose of this study was to establish a validated electronic medical record definition for diabetes. We constructed a retrospective cohort using health administrative data from the Institute for Clinical Evaluative Sciences Ontario Diabetes Database linked with electronic medical records from the Deliver Primary Healthcare Information Project using data from 1 April 2006 - 31 March 2008 (N = 19,443). We systematically examined eight definitions for diabetes diagnosis, both established and proposed. The definition that identified the highest number of patients with diabetes (N = 2,180) while limiting to those with the highest probability of having diabetes was: individuals with ≥2 abnormal plasma glucose tests, or diabetes on the problem list, or insulin prescription, or ≥2 oral anti-diabetic agents, or HbA1c ≥6.5%. Compared to the Ontario Diabetes Database, this definition identified 13% more patients while maintaining good sensitivity (75%) and specificity (98%). This study establishes the feasibility of developing an electronic medical record standard definition of diabetes and validates an algorithm for use in this context. While the algorithm may need to be tailored to fit available data in different electronic medical records, it contributes to the establishment of validated disease registries with the goal of enhancing research, and enabling quality improvement in clinical care and patient self-management.
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影响因子：
16.2
作者：
Carson AP;Reynolds K;Fonseca VA;Muntner P
通讯作者：
Muntner P
影响因子：
4
作者：
Asghari, Shabnam;Courteau, Josiane;Vanasse, Alain
通讯作者：
Vanasse, Alain
影响因子：
5.4
作者：
Gabbay, Robert A;Khan, Leila;Peterson, Kevin L
通讯作者：
Peterson, Kevin L
影响因子：
2.8
作者：
Wilson, Sarah E.;Lipscombe, Lorraine L.;Manuel, Douglas G.
通讯作者：
Manuel, Douglas G.
影响因子：
168.9
作者：
Lipscombe, Lorraine L.;Hux, Janet E.
通讯作者：
Hux, Janet E.