Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Pharmacoepidemiol Drug Saf. 2019 May;28(5):632-639. doi: 10.1002/pds.4718. Epub 2019 Jan 24.
PCORnet, the National Patient-Centered Clinical Research Network, represents an innovative system for the conduct of observational and pragmatic studies. We describe the identification and validation of a retrospective cohort of patients with type 2 diabetes (T2DM) from four PCORnet sites.
We adapted existing computable phenotypes (CP) for the identification of patients with T2DM and evaluated their performance across four PCORnet sites (2012-2016). Patients entered the cohort on the earliest date they met one of three CP categories: (CP1) coded T2DM diagnosis (ICD-9/ICD-10) and an antidiabetic prescription, (CP2) diagnosis and glycosylated hemoglobin (HbA1c) ≥6.5%, or (CP3) an antidiabetic prescription and HbA1c ≥6.5%. We required evidence of health care utilization in each of the 2 prior years for each patient, as we also developed an incident T2DM CP to identify the subset of patients without documentation of T2DM in the 365 days before t . Among a systematic sample of patients, we calculated the positive predictive value (PPV) for the T2DM CP and incident-T2DM CP using electronic health record (EHR) review as reference.
The CP identified 50 657 patients with T2DM. The PPV of patients randomly selected for validation was 96.2% (n = 1572; CI:95.1-97.0) and was consistently high across sites. The PPV for the incident-T2DM CP was 5.8% (CI:4.5-7.5).
The T2DM CP accurately and efficiently identified patients with T2DM across multiple sites that participate in PCORnet, although the incident T2DM CP requires further study. PCORnet is a valuable data source for future epidemiological and comparative effectiveness research among patients with T2DM.
PCORnet 是国家以患者为中心的临床研究网络，代表了一种用于进行观察性和实用研究的创新系统。我们描述了从四个 PCORnet 站点中确定和验证 2 型糖尿病 (T2DM) 患者的回顾性队列。
我们针对 T2DM 患者的识别改编了现有的可计算表型 (CP)，并在四个 PCORnet 站点 (2012-2016 年) 对其性能进行了评估。患者最早在满足以下三个 CP 类别之一时进入队列：(CP1) 编码 T2DM 诊断 (ICD-9/ICD-10) 和抗糖尿病处方，(CP2) 诊断和糖化血红蛋白 (HbA1c) ≥6.5%，或 (CP3) 抗糖尿病处方和 HbA1c ≥6.5%。我们要求每位患者在前两年中有证据表明医疗保健的使用，因为我们还开发了一个 T2DM 的发病 CP，以识别在 t 之前的 365 天内没有 T2DM 记录的患者子集。在系统选择的患者中，我们使用电子健康记录 (EHR) 审查作为参考，计算 T2DM CP 和发病 T2DM CP 的阳性预测值 (PPV)。
CP 确定了 50657 名 T2DM 患者。随机选择进行验证的患者的 PPV 为 96.2% (n = 1572; CI:95.1-97.0)，并且在各个站点均保持较高水平。发病 T2DM CP 的 PPV 为 5.8% (CI:4.5-7.5)。
T2DM CP 可准确有效地在参与 PCORnet 的多个站点中识别 T2DM 患者，尽管发病 T2DM CP 需要进一步研究。PCORnet 是 T2DM 患者未来进行流行病学和比较效果研究的有价值的数据来源。
