Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts 02215-3920, USA.
Am J Prev Med. 2009 Dec;37(6):552-5. doi: 10.1016/j.amepre.2009.08.022.
Studies of influenza vaccination using electronic medical records rely on accurate classification of vaccination status. Vaccinations not entered into electronic records would be unavailable for study.
This study evaluated the sensitivity and negative predictive value (NPV) of electronic records for influenza vaccination and factors associated with failure to capture vaccinations.
In four diverse medical care organizations in the Vaccine Safety Datalink, those aged 50-79 years with no influenza vaccination record during the 2007-2008 season were surveyed by telephone, and electronic records were analyzed in 2008. The sensitivity and NPV of electronic records were estimated, using survey responses as the gold standard. Logistic regression models determined associations between 1-NPV and demographic factors, risk of influenza complications, and healthcare utilization levels.
Data were obtained for 933 survey participants and 1,085,916 medical care organization members. Sites varied significantly in the sensitivity (51%, 68%, 79%, 89%) and NPV (46%, 62%, 66%, 87%) of electronic records. In multivariate analysis, the rate of failure to capture vaccinations was significantly higher for those aged 65-79 years than for those aged 50-64 years at three sites. Of vaccinations not captured by electronic records, 58% were reportedly administered in nontraditional settings, usually workplaces; the rest were given within the sites.
Influenza vaccination studies relying on electronic records may misclassify substantial proportions of vaccinated individuals as unvaccinated, producing biased estimates of vaccine effectiveness. Sites with limited sensitivity to capture vaccinations administered within their organization should seek possible remedies. More complete capture of vaccinations administered to older patients and in nontraditional settings would further reduce misclassification.
利用电子病历研究流感疫苗接种情况依赖于接种状态的准确分类。未输入电子记录的疫苗接种将无法进行研究。
本研究评估了电子记录在流感疫苗接种中的敏感性和阴性预测值（NPV），以及与未能捕获疫苗接种相关的因素。
在疫苗安全数据链中的四个不同医疗保健组织中，2007-2008 赛季期间没有流感疫苗接种记录且年龄在 50-79 岁之间的人通过电话进行了调查，并在 2008 年分析了电子记录。使用调查结果作为金标准，估计了电子记录的敏感性和 NPV。逻辑回归模型确定了 NPV 与人口统计学因素、流感并发症风险和医疗保健利用水平之间的关联。
从 933 名调查参与者和 1085916 名医疗保健组织成员中获得了数据。各站点的电子记录敏感性（51%、68%、79%、89%）和 NPV（46%、62%、66%、87%）差异显著。在多变量分析中，在三个站点中，65-79 岁年龄组未能捕获疫苗接种的比例明显高于 50-64 岁年龄组。在电子记录中未捕获的疫苗接种中，58%报告是在非传统场所（通常是工作场所）接种的，其余的则是在接种点接种的。
依赖电子记录的流感疫苗接种研究可能会错误地将大量接种疫苗的个体归类为未接种疫苗，从而对疫苗有效性产生有偏差的估计。那些对捕获接种疫苗的敏感性有限的接种站点应寻求可能的补救措施。更全面地捕获在传统场所之外接种的老年患者的疫苗接种情况，将进一步减少错误分类。
