Development and Validation of an Algorithm to Accurately Identify Atopic Eczema Patients in Primary Care Electronic Health Records from the UK
Development and Validation of an Algorithm to Accurately Identify Atopic Eczema Patients in Primary Care Electronic Health Records from the UK
复制标题
DOI：
10.1016/j.jid.2017.03.029
复制
发表时间：
2017-08-01
影响因子：
6.5
通讯作者：
Langan, Sinead M.
中科院分区：
文献类型：
--
作者：
Abuabara, Katrina;Magyari, Alexa M.;Langan, Sinead M.
电子健康记录为临床和流行病学研究带来了巨大的希望。使用这些数据进行特应性湿疹（AE）研究是具有挑战性的，因为它的情节和异质性。我们试图开发和验证一种诊断算法，该算法根据英国健康改善网络中使用的电子记录代码识别AE病例。我们发现，对于任何皮肤定向治疗，至少有五个诊断代码中的一个加上两个治疗代码可能准确识别AE患者。为了验证该算法，向200名随机选择的儿童和成人的医生发送了一份调查问卷。主要结局，即医生确认的AE诊断的阳性预测值为86%（95%置信区间= 80-91）。其他标准将PPV提高至95%，但将错过高达89%的经医生证实的AE个体。个体首次和末次输入的诊断代码与医生确认的发病年龄和末次疾病活动一致;平均差异分别为0.8年（95%置信区间= -0.3至1.9）和-1.3年（95%置信区间= -2.5至0.1）。诊断和处方代码的组合可用于可靠地估计英国健康改善网络初级保健电子健康记录中AE的诊断和持续时间。
Electronic health records hold great promise for clinical and epidemiologic research. Undertaking atopic eczema (AE) research using such data is challenging because of its episodic and heterogeneous nature. We sought to develop and validate a diagnostic algorithm that identifies AE cases based on codes used for electronic records used in the UK Health Improvement Network. We found that at least one of five diagnosis codes plus two treatment codes for any skin-directed therapy were likely to accurately identify patients with AE. To validate this algorithm, a questionnaire was sent to the physicians of 200 randomly selected children and adults. The primary outcome, positive predictive value for a physician-confirmed diagnosis of AE, was 86% (95% confidence interval = 80-91). Additional criteria increased the PPV up to 95% but would miss up to 89% of individuals with physician-confirmed AE. The first and last entered diagnosis codes for individuals showed good agreement with the physician-confirmed age at onset and last disease activity; the mean difference was 0.8 years (95% confidence interval = -0.3 to 1.9) and -1.3 years (95% confidence interval = -2.5 to -0.1), respectively. A combination of diagnostic and prescription codes can be used to reliably estimate the diagnosis and duration of AE from The Health Improvement Network primary care electronic health records in the UK.