OCHIN, Inc, Portland, OR, USA.
Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA.
J Natl Cancer Inst. 2021 Jul 1;113(7):924-932. doi: 10.1093/jnci/djaa210.
Many cancer survivors receive primary care in community health centers (CHCs). Cancer history is an important factor to consider in the provision of primary care, yet little is known about the completeness or accuracy of cancer history data contained in CHC electronic health records (EHRs).
We probabilistically linked EHR data from more than1.5 million adult CHC patients to state cancer registries in California, Oregon, and Washington and estimated measures of agreement (eg, kappa, sensitivity, specificity). We compared demographic and clinical characteristics of cancer patients as estimated by each data source, evaluating distributional differences with absolute standardized mean differences.
A total 74 707 cancer patients were identified between the 2 sources (EHR only, n = 22 730; registry only, n = 23 616; both, n = 28 361). Nearly one-half of cancer patients identified in registries were missing cancer documentation in the EHR. Overall agreement of cancer ascertainment in the EHR vs cancer registries (gold standard) was moderate (kappa = 0.535). Cancer site-specific agreement ranged from substantial (eg, prostate and female breast; kappa > 0.60) to fair (melanoma and cervix; kappa < 0.40). Comparing population characteristics of cancer patients as ascertained from each data source, groups were similar for sex, age, and federal poverty level, but EHR-recorded cases showed greater medical complexity than those ascertained from cancer registries.
Agreement between EHR and cancer registry data was moderate and varied by cancer site. These findings suggest the need for strategies to improve capture of cancer history information in CHC EHRs to ensure adequate delivery of care and optimal health outcomes for cancer survivors.
许多癌症幸存者在社区卫生中心（CHC）接受初级保健。癌症病史是提供初级保健时需要考虑的一个重要因素，但目前尚不清楚 CHC 电子健康记录（EHR）中包含的癌症病史数据的完整性或准确性。
我们通过概率方法将超过 150 万成年 CHC 患者的 EHR 数据与加利福尼亚州、俄勒冈州和华盛顿州的州癌症登记处进行了链接，并估计了衡量一致性的指标（例如，kappa、敏感性、特异性）。我们比较了每个数据源估计的癌症患者的人口统计学和临床特征，通过绝对标准化均数差异评估分布差异。
从两个来源（仅 EHR，n=22730；仅登记处，n=23616；两者均有，n=28361）共确定了 74707 例癌症患者。在登记处确定的癌症患者中，近一半在 EHR 中没有癌症记录。EHR 与癌症登记处（金标准）相比，癌症检出的总体一致性为中度（kappa=0.535）。癌症部位特异性一致性从实质性（例如前列腺和女性乳房；kappa>0.60）到公平（黑色素瘤和宫颈癌；kappa<0.40）不等。比较从每个数据源确定的癌症患者的人口特征，组间在性别、年龄和联邦贫困水平上相似，但 EHR 记录的病例比从癌症登记处确定的病例表现出更高的医疗复杂性。
EHR 和癌症登记处数据之间的一致性是中度的，并且因癌症部位而异。这些发现表明，需要制定策略来改善 CHC EHR 中癌症病史信息的采集，以确保为癌症幸存者提供足够的护理和最佳的健康结果。
