CARES: an interactive tool for case-crossover analyses of electronic medical records for patient safety
CARES: an interactive tool for case-crossover analyses of electronic medical records for patient safety
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DOI：
10.1093/jamia/ocw132
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发表时间：
2017-03-01
影响因子：
6.4
通讯作者：
Ficheur, Gregoire
中科院分区：
文献类型：
--
作者：
Caron, Alexandre;Chazard, Emmanuel;Ficheur, Gregoire
背景：医疗程序后发生不良事件的重大风险支持基于对电子病历收集的分析的临床流行病学方法。数据分析工具可能有助于临床流行病学家制定更合适的病例交叉设计，以监测患者的安全。目的：开发和评估交互式工具的方法学质量，供临床流行病学家使用，以系统地设计大型电子病历数据库的病例交叉分析。材料和方法：我们开发了IT-CARE，一个实施病例交叉设计的分析工具，以探索暴露与结果之间的关联。暴露和结果由临床流行病学家通过用户界面屏幕输入的代码列表来定义。我们对来自法国国家住院数据库的数据进行了IT-CARE测试，该数据库记录了2007至2013年间1.7亿住院患者的诊断和医疗程序。我们将我们的分析结果与文献中关于分娩后血栓栓塞风险和全髋关节置换术后出血风险的参考数据进行了比较。结果：CARE提供了一个用户界面，其中包括3列：(I)左栏中的结果标准，(Ii)右栏中的暴露标准，以及(Iii)中间栏中的估计风险(优势比，以图形和表格的形式显示)。估计的优势比与参考文献数据一致。讨论：IT-CARE可能通过促进对医疗程序后不良事件的临床流行病学研究来提高患者的安全性。该工具的可用性必须在进一步的研究中进行评估和改进。
Background: The significant risk of adverse events following medical procedures supports a clinical epidemiological approach based on the analyses of collections of electronic medical records. Data analytical tools might help clinical epidemiologists develop more appropriate case-crossover designs for monitoring patient safety.Objective: To develop and assess the methodological quality of an interactive tool for use by clinical epidemiologists to systematically design case-crossover analyses of large electronic medical records databases.Material and Methods: We developed IT-CARES, an analytical tool implementing case-crossover design, to explore the association between exposures and outcomes. The exposures and outcomes are defined by clinical epidemiologists via lists of codes entered via a user interface screen. We tested IT-CARES on data from the French national inpatient stay database, which documents diagnoses and medical procedures for 170 million inpatient stays between 2007 and 2013. We compared the results of our analysis with reference data from the literature on thromboembolic risk after delivery and bleeding risk after total hip replacement.Results: IT-CARES provides a user interface with 3 columns: (i) the outcome criteria in the left-hand column, (ii) the exposure criteria in the right-hand column, and (iii) the estimated risk (odds ratios, presented in both graphical and tabular formats) in the middle column. The estimated odds ratios were consistent with the reference literature data.Discussion: IT-CARES may enhance patient safety by facilitating clinical epidemiological studies of adverse events following medical procedures. The tool's usability must be evaluated and improved in further research.