Department of Medicine, Beth-Israel Deaconess Medical Center, Boston, MA, USA.
J Public Health Manag Pract. 2012 May-Jun;18(3):209-14. doi: 10.1097/PHH.0b013e31821f2d73.
Public health surveillance systems for acute hepatitis are limited: clinician reporting is insensitive and electronic laboratory reporting is nonspecific. Insurance claims and electronic health records are potential alternative sources.
To compare the utility of laboratory data, diagnosis codes, and electronic health record combination data (current and prior viral hepatitis studies, liver function tests, and diagnosis codes) for acute hepatitis A and B surveillance.
Retrospective chart review.
Massachusetts ambulatory practice serving 350 000 patients per year.
All patients seen between 1990 and 2008.
Sensitivity and positive predictive value of immunoglobulin M (IgM), International Classification of Disease-Ninth Revision (ICD-9) diagnosis codes, and combination electronic health record data for acute hepatitis A and B.
During the study period, there were 111 patients with positive hepatitis A IgMs, 154 with acute hepatitis A ICD-9 codes, and 77 with positive IgM and elevated liver function tests. On review, 79 cases were confirmed. Sensitivity and positive predictive value were 100% and 71% (95% confidence interval, 62%-79%) for IgM, 94% (92%-100%) and 48% (40%-56%) for ICD-9 codes and 97% (92%-100%) and 100% (96%-100%) for combination electronic health record data. There were 14 patients with positive hepatitis B core IgMs, 2564 with acute hepatitis B ICD-9 codes, and 125 with suggestive combinations of electronic health record data. Acute hepatitis B was confirmed in 122 patients. Sensitivity and positive predictive value were 9.4% (5.2%-16%) and 86% (60%-98%) for hepatitis B core IgM, 73% (65%-80%) and 3.6% (2.9%-4.4%) for ICD-9 codes, and 96% (91%-99%) and 98% (94%-99%) for electronic health record data.
Laboratory surveillance using IgM tests overestimates the burden of acute hepatitis A and underestimates the burden of acute hepatitis B. Claims data are subject to many false positives. Electronic health record data are both sensitive and predictive. Electronic health record-based surveillance systems merit development.
急性肝炎的公共卫生监测系统有限：临床医生报告不敏感，电子实验室报告特异性不强。保险索赔和电子健康记录是潜在的替代来源。
比较实验室数据、诊断代码和电子健康记录组合数据（当前和既往病毒性肝炎研究、肝功能检查和诊断代码）在急性肝炎 A 和 B 监测中的应用。
回顾性图表审查。
马萨诸塞州的一个门诊实践，每年为 35 万名患者提供服务。
1990 年至 2008 年间就诊的所有患者。
免疫球蛋白 M（IgM）、国际疾病分类第 9 版（ICD-9）诊断代码和电子健康记录组合数据对急性肝炎 A 和 B 的敏感性和阳性预测值。
在研究期间，有 111 例患者的肝炎 A IgM 呈阳性，154 例患者的急性肝炎 A ICD-9 代码呈阳性，77 例患者的 IgM 呈阳性且肝功能升高。经审查，有 79 例得到确认。IgM 的敏感性和阳性预测值分别为 100%和 71%（95%置信区间，62%-79%），ICD-9 代码分别为 94%（92%-100%）和 48%（40%-56%），电子健康记录组合数据分别为 97%（92%-100%）和 100%（96%-100%）。有 14 例患者的乙型肝炎核心 IgM 呈阳性，2564 例患者的急性乙型肝炎 ICD-9 代码呈阳性，125 例患者的电子健康记录数据有提示性组合。有 122 例乙型肝炎得到确认。乙型肝炎核心 IgM 的敏感性和阳性预测值分别为 9.4%（5.2%-16%）和 86%（60%-98%），ICD-9 代码分别为 73%（65%-80%）和 3.6%（2.9%-4.4%），电子健康记录数据分别为 96%（91%-99%）和 98%（94%-99%）。
使用 IgM 检测的实验室监测高估了急性肝炎 A 的负担，低估了急性肝炎 B 的负担。索赔数据存在许多假阳性。电子健康记录数据既敏感又具有预测性。基于电子健康记录的监测系统值得开发。
