Patient characteristics associated with venous thromboembolic events: a cohort study using pooled electronic health record data
Patient characteristics associated with venous thromboembolic events: a cohort study using pooled electronic health record data
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DOI：
10.1136/amiajnl-2011-000782
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发表时间：
2012-11-01
影响因子：
6.4
通讯作者：
Jain, Anil K.
中科院分区：
文献类型：
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作者：
Kaelber, David C.;Foster, Wendy;Jain, Anil K.
目的 证明使用不同电子健康记录 (EHR) 的多个医疗保健系统的去识别化临床数据有效用于大型回顾性队列研究的潜力。材料和方法获得了来自具有不同 ERR 的多个不同医疗保健系统的 959 030 名患者的数据。使用通用本体对数据进行标准化和归一化，并可通过符合 HIPAA 要求的、患者去识别化的 Web 应用程序（Explore；Explorys Inc）进行搜索。 1999 年至 2011 年期间，在多个医疗保健系统中就诊的患者年龄为 26 岁或以上，数据来自 EHR。结果比较肥胖、身高体重指数正常的受试者、矮小的受试者，女性静脉血栓栓塞事件 (VIE) OR 为 1.83（95% CI 1.76 至 1.91），男性为 1.21（1.10 至 1.32）。体重对 VIE 的影响比身高更大。与白种人相比，西班牙裔/拉丁裔受试者的 VIE 风险要低得多（女性 OR 0.47、0.41 至 0.55；男性 OR 0.24、0.20 至 0.28），而非洲裔美国人的风险则要高得多（女性 OR 1.83、1.76 至 1.91；男性 OR 1.58、1.50 至 1.66）。这项针对近 100 万名患者的 13 年回顾性研究由五位作者在 11 周内进行了大约 125 小时，由五位作者兼职进行。讨论 随着研究信息学工具的发展以及 ERR 中可用的更多临床数据，研究和了解临床研究信息学改变进行某些类型的临床研究所需的规模和资源的独特机会非常重要。结论 有了正确的临床研究信息学工具和 EHR 数据，某些类型的超大型队列研究可以用最少的时间完成。资源。
Objective To demonstrate the potential of de-identified clinical data from multiple healthcare systems using different electronic health records (EHR) to be efficiently used for very large retrospective cohort studies.Materials and methods Data of 959 030 patients, pooled from multiple different healthcare systems with distinct ERR, were obtained. Data were standardized and normalized using common ontologies, searchable through a HIPAA-compliant, patient de-identified web application (Explore; Explorys Inc). Patients were 26 years or older seen in multiple healthcare systems from 1999 to 2011 with data from EHR.Results Comparing obese, tall subjects with normal body mass index, short subjects, the venous thromboembolic events (VIE) OR was 1.83 (95% CI 1.76 to 1.91) for women and 1.21 (1.10 to 1.32) for men. Weight had more effect then height on VIE. Compared with Caucasian, Hispanic/Latino subjects had a much lower risk of VIE (female OR 0.47, 0.41 to 0.55; male OR 0.24, 0.20 to 0.28) and African-Americans a substantially higher risk (female OR 1.83, 1.76 to 1.91; male OR 1.58, 1.50 to 1.66). This 13-year retrospective study of almost one million patients was performed over approximately 125 h in 11 weeks, part time by the five authors.Discussion As research informatics tools develop and more clinical data become available in ERR, it is important to study and understand unique opportunities for clinical research informatics to transform the scale and resources needed to perform certain types of clinical research.Conclusions With the right clinical research informatics tools and EHR data, some types of very large cohort studies can be completed with minimal resources.