Newton-Dame Remle, McVeigh Katharine H, Schreibstein Lauren, Perlman Sharon, Lurie-Moroni Elizabeth, Jacobson Laura, Greene Carolyn, Snell Elisabeth, Thorpe Lorna E
Formerly New York City Department of Health and Mental Hygiene.
New York City Department of Health and Mental Hygiene.
EGEMS (Wash DC). 2016 Dec 15;4(1):1265. doi: 10.13063/2327-9214.1265. eCollection 2016.
Electronic health records (EHRs) have the potential to offer real-time, inexpensive standardized health data about chronic health conditions. Despite rapid expansion, EHR data evaluations for chronic disease surveillance have been limited. We present design and methods for the New York City (NYC) Macroscope, an EHR-based chronic disease surveillance system. This methods report is the first in a three part series describing the development and validation of the NYC Macroscope. This report describes in detail the infrastructure underlying the NYC Macroscope; indicator definitions; design decisions that were made to maximize data quality; characteristics of the population sampled; completeness of data collected; and lessons learned from doing this work. The second report describes the methods used to evaluate the validity and robustness of NYC Macroscope prevalence estimates; presents validation results for estimates of obesity, smoking, depression and influenza vaccination; and discusses the implications of our findings for NYC and for other jurisdictions embarking on similar work. The third report applies the same validation methods to metabolic outcomes, including the prevalence, treatment and control of diabetes, hypertension and hyperlipidemia.
We designed the NYC Macroscope for comparison to a local "gold standard," the 2013-14 NYC Health and Nutrition Examination Survey, and the telephonic 2013 Community Health Survey. NYC Macroscope indicators covered prevalence, treatment, and control of diabetes, hypertension, and hyperlipidemia; and prevalence of influenza vaccination, obesity, depression and smoking. Indicators were stratified by age, sex, and neighborhood poverty, and weighted to the in-care NYC population and limited to primary care patients. Indicator queries were distributed to a virtual network of primary care practices; 392 practices and 716,076 adult patients were retained in the final sample.
The NYC Macroscope covered 10% of primary care providers and 15% of all adult patients in NYC in 2013 (8-47% of patients by neighborhood). Data completeness varied by domain from 98% for blood pressure among patients with hypertension to 33% for depression screening.
Design and validation efforts undertaken by NYC are described here to provide one potential blueprint for leveraging EHRs for population health monitoring. To replicate a model like NYC Macroscope, jurisdictions should establish buy-in; build informatics capacity; use standard, simple case defnitions; establish documentation quality thresholds; restrict to primary care providers; and weight the sample to a target population.
电子健康记录（EHRs）有潜力提供有关慢性健康状况的实时、低成本标准化健康数据。尽管发展迅速，但用于慢性病监测的电子健康记录数据评估一直很有限。我们介绍了纽约市宏观镜（NYC Macroscope）的设计和方法，这是一个基于电子健康记录的慢性病监测系统。这份方法报告是描述纽约市宏观镜开发和验证的三部分系列中的第一部分。本报告详细描述了纽约市宏观镜的基础架构；指标定义；为最大限度提高数据质量而做出的设计决策；抽样人群的特征；所收集数据的完整性；以及从这项工作中吸取的经验教训。第二份报告描述了用于评估纽约市宏观镜患病率估计值的有效性和稳健性的方法；给出了肥胖、吸烟、抑郁症和流感疫苗接种估计值的验证结果；并讨论了我们的研究结果对纽约市以及其他开展类似工作的司法管辖区的影响。第三份报告将相同的验证方法应用于代谢结果，包括糖尿病、高血压和高脂血症的患病率、治疗和控制情况。
我们设计纽约市宏观镜是为了与当地的“金标准”（2013 - 14年纽约市健康与营养检查调查）以及2013年电话社区健康调查进行比较。纽约市宏观镜指标涵盖糖尿病、高血压和高脂血症的患病率、治疗和控制情况；以及流感疫苗接种、肥胖、抑郁症和吸烟的患病率。指标按年龄、性别和邻里贫困程度进行分层，并根据纽约市接受治疗的人群进行加权，且仅限于初级保健患者。指标查询被分发给初级保健机构的虚拟网络；最终样本保留了392个机构和716,076名成年患者。
2013年，纽约市宏观镜涵盖了纽约市10%的初级保健提供者和15%的成年患者（各社区患者比例为8 - 47%）。数据完整性因领域而异，从高血压患者血压数据的98%到抑郁症筛查数据的33%不等。
这里描述了纽约市所做的设计和验证工作，以提供一个利用电子健康记录进行人群健康监测的潜在蓝图。要复制像纽约市宏观镜这样的模型，司法管辖区应获得各方支持；建立信息学能力；使用标准、简单的病例定义；设定文档质量阈值；限于初级保健提供者；并将样本加权到目标人群。
