Electronic Health Records As a Platform for Audiological Research: Data Validity, Patient Characteristics, and Hearing-Aid Use Persistence Among 731,213 U.S. Veterans.
Electronic Health Records As a Platform for Audiological Research: Data Validity, Patient Characteristics, and Hearing-Aid Use Persistence Among 731,213 U.S. Veterans.
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DOI：
10.1097/aud.0000000000000980
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Naylor G
中科院分区：
文献类型：
--
作者：
Saunders GH;Dillard LK;Zobay O;Cannon JB;Naylor G
补充数字内容可在文本中找到。这篇文章概述了在接受HA的美国退伍军人的大样本中听力学、一般健康和助听器（HA）结果数据。本文还为一系列探讨各种因素与HA结果之间关系的论文提供了基础。患者样本是2012年4月至2014年10月期间通过美国退伍军人健康管理局远程订单输入系统订购HAs的所有患者（n = 731,213）。对于这些患者，存储在各种数据库中的退伍军人事务部电子健康记录（EHRs）提供了人口统计数据、收到的诊断和程序代码（2007年至2017年）、听力测量、验合后6个月的自我报告结果和HA电池订单（至2017年）。进行了数据清理和准备，并参考对其他从事类似研究的研究人员提供潜在价值的见解进行了讨论。随着时间的推移，使用HA电池订单数据来获得长期HA使用持久性的度量。描述性统计用于描述样本特征，与其他数据的比较分析支持基本效度评估，双变量分析探讨了拟合后2年患者特征与HA使用持久性之间的新关联。经过广泛的清理和数据准备，数据在不同的指标上显示出合理的特征，并与其他已发表的数据进行比较，显示出足够的有效性。此外，与其他主要慢性疾病的治疗持久性数据相比，HA使用持久性的比率是有利的。数据还显示，某些合并症（帕金森病、糖尿病、关节炎和视力障碍）的存在与明显降低的HA使用持久性相关，就像先前的住院患者（特别是在新的HA接受者中）一样，总的来说，多病水平的增加与HA使用持久性降低有关。尽管事实是，从现有记录中得出相关的听力学护理过程变量并不简单，特别是关于HA装配日期的定义，以及使用电池订购数据来确定长期HA使用的持久性。我们已经表明，在听力学中使用电子病历有可能为临床实践模式、听力学结果以及与听力有关的因素与临床人群中其他健康状况之间的关系提供新的见解，尽管缺乏对可用变量的控制和数据输入方式的限制存在潜在的陷阱。因此，我们得出结论，使用电子病历的研究有可能成为听力学领域基于人群和流行病学研究的整体补充。
Supplemental Digital Content is available in the text. This article presents a summary of audiological, general health, and hearing aid (HA) outcome data in a large sample of U.S. Veterans receiving HAs. The current article also provides the foundation for a series of papers that will explore relationships between a wide range of factors and HA outcomes. The patient sample is all (n = 731,213) patients for whom HAs were ordered between April 2012 and October 2014 through the U.S. Veterans Health Administration Remote Order Entry System. For these patients, Veterans Affairs electronic health records (EHRs) stored in various databases provided data on demographics, received diagnostic and procedure codes (2007 to 2017), audiometry, self-reported outcomes up to 6 months postfitting, and HA battery orders (to 2017). Data cleaning and preparation was carried out and is discussed with reference to insights that provide potential value to other researchers pursuing similar studies. HA battery order data over time was used to derive a measure of long-term HA use persistence. Descriptive statistics were used to characterize the sample, comparative analyses against other data supported basic validity assessment, and bivariate analyses probed novel associations between patient characteristics and HA use persistence at 2 years postfitting. Following extensive cleaning and data preparation, the data show plausible characteristics on diverse metrics and exhibit adequate validity based on comparisons with other published data. Further, rates of HA use persistence are favorable when compared against therapy persistence data for other major chronic conditions. The data also show that the presence of certain comorbid conditions (Parkinson’s disease, diabetes, arthritis, and visual impairment) are associated with significantly lower HA use persistence, as are prior inpatient admissions (especially among new HA recipients), and that increasing levels of multimorbidity, in general, are associated with decreasing HA use persistence. This is all despite the fact that deriving relevant audiological care-process variables from the available records was not straightforward, especially concerning the definition of the date of HA fitting, and the use of battery ordering data to determine long-term HA use persistence. We have shown that utilizing EHRs in audiology has the potential to provide novel insights into clinical practice patterns, audiologic outcomes, and relations between factors pertaining to hearing and to other health conditions in clinical populations, despite the potential pitfalls regarding the lack of control over the variables available and limitations on how the data are entered. We thus conclude that research using EHRs has the potential to be an integral supplement to population-based and epidemiologic research in the field of audiology.