Use of Electronic Health Records and Geographic Information Systems in Public Health Surveillance of Type 2 Diabetes: A Feasibility Study.
Use of Electronic Health Records and Geographic Information Systems in Public Health Surveillance of Type 2 Diabetes: A Feasibility Study.
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DOI：
10.2196/publichealth.4319
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发表时间：
2016-01-01
影响因子：
8.5
通讯作者：
Boavida, Jose Manuel
中科院分区：
文献类型：
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作者：
Laranjo, Liliana;Rodrigues, David;Boavida, Jose Manuel
背景：电子健康记录（EHRs）中常规收集的数据为实时监测慢性健康状况提供了独特的机会。地理信息系统（GIS）可能是对这些数据分析的重要补充。目的：本研究的目的是探讨在葡萄牙使用初级保健电子病历和地理信息系统进行人口保健管理和慢性病公共卫生监测的可行性。具体来说，我们选择2型糖尿病作为案例研究，目的是绘制其患病率和合并症的存在，并确定可能存在心血管并发症风险的人群。方法：横断面研究，使用来自514个初级保健中心的个人水平数据，收集自三种不同类型的电子病历。数据来自成人2型糖尿病患者（根据国际初级保健分类[ICPC-2]代码T90在问题列表中确定）。GISs用于绘制里斯本和塔古斯河谷地区各教区的糖尿病患病率和合并症（高血压、血脂异常和肥胖）。采用描述性统计和多元逻辑回归进行数据分析。结果：我们确定了205,068例诊断为2型糖尿病的个体，在研究人群中患病率为5.6%（205,068/3,659,868）。这些患者的平均年龄为67.5岁，71%（144,938/205,068）存在高血压。各教区诊断出的合并症有相当大的差异。在调整年龄和性别后，糖尿病合并高血压或血脂异常患者被诊断为心血管并发症的几率更高（高血压优势比[or] 2.16，可信区间[CI] 2.10-2.22；血脂异常优势比[or] 1.57，可信区间[CI] 1.54-1.60）。结论：来自电子病历的个人数据可能在慢性病监测中发挥重要作用，即通过GIS的使用。提高数据的质量和全面性，即通过患者参与其医疗记录，对于提高这一方法的可行性和实用性至关重要。
BACKGROUND: Data routinely collected in electronic health records (EHRs) offer a unique opportunity to monitor chronic health conditions in real-time. Geographic information systems (GIS) may be an important complement in the analysis of those data.OBJECTIVE: The aim of this study was to explore the feasibility of using primary care EHRs and GIS for population care management and public health surveillance of chronic conditions, in Portugal. Specifically, type 2 diabetes was chosen as a case study, and we aimed to map its prevalence and the presence of comorbidities, as well as to identify possible populations at risk for cardiovascular complications.METHODS: Cross-sectional study using individual-level data from 514 primary care centers, collected from three different types of EHRs. Data were obtained on adult patients with type 2 diabetes (identified by the International Classification of Primary Care [ICPC-2] code, T90, in the problems list). GISs were used for mapping the prevalence of diabetes and comorbidities (hypertension, dyslipidemia, and obesity) by parish, in the region of Lisbon and Tagus Valley. Descriptive statistics and multivariate logistic regression were used for data analysis.RESULTS: We identified 205,068 individuals with the diagnosis of type 2 diabetes, corresponding to a prevalence of 5.6% (205,068/3,659,868) in the study population. The mean age of these patients was 67.5 years, and hypertension was present in 71% (144,938/205,068) of all individuals. There was considerable variation in diagnosed comorbidities across parishes. Diabetes patients with concomitant hypertension or dyslipidemia showed higher odds of having been diagnosed with cardiovascular complications, when adjusting for age and gender (hypertension odds ratio [OR] 2.16, confidence interval [CI] 2.10-2.22; dyslipidemia OR 1.57, CI 1.54-1.60).CONCLUSIONS: Individual-level data from EHRs may play an important role in chronic disease surveillance, namely through the use of GIS. Promoting the quality and comprehensiveness of data, namely through patient involvement in their medical records, is crucial to enhance the feasibility and usefulness of this approach.