Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL.
Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, FL.
JCO Clin Cancer Inform. 2021 May;5:518-526. doi: 10.1200/CCI.20.00187.
Patients with cancer who use tobacco experience reduced treatment effectiveness, increased risk of recurrence and mortality, and diminished quality of life. Accurate tobacco use documentation for patients with cancer is necessary for appropriate clinical decision making and cancer outcomes research. Our aim was to assess agreement between electronic health record (EHR) smoking status data and cancer registry data.
We identified all patients with cancer seen at University of Florida Health from 2015 to 2018. Structured EHR smoking status was compared with the tumor registry smoking status for each patient. Sensitivity, specificity, positive predictive values, negative predictive values, and Kappa statistics were calculated. We used logistic regression to determine if patient characteristics were associated with odds of agreement in smoking status between EHR and registry data.
We analyzed 11,110 patient records. EHR smoking status was documented for nearly all (98%) patients. Overall kappa (0.78; 95% CI, 0.77 to 0.79) indicated moderate agreement between the registry and EHR. The sensitivity was 0.82 (95% CI, 0.81 to 0.84), and the specificity was 0.97 (95% CI, 0.96 to 0.97). The logistic regression results indicated that agreement was more likely among patients who were older and female and if the EHR documentation occurred closer to the date of cancer diagnosis.
Although documentation of smoking status for patients with cancer is standard practice, we only found moderate agreement between EHR and tumor registry data. Interventions and research using EHR data should prioritize ensuring the validity of smoking status data. Multilevel strategies are needed to achieve consistent and accurate documentation of smoking status in cancer care.
患有癌症并使用烟草的患者会降低治疗效果，增加复发和死亡风险，并降低生活质量。准确记录癌症患者的烟草使用情况对于适当的临床决策和癌症结局研究是必要的。我们的目的是评估电子健康记录（EHR）吸烟状况数据与癌症登记数据之间的一致性。
我们确定了 2015 年至 2018 年期间在佛罗里达大学健康中心就诊的所有癌症患者。比较了每位患者的 EHR 吸烟状况与肿瘤登记处的吸烟状况。计算了敏感性、特异性、阳性预测值、阴性预测值和 Kappa 统计量。我们使用逻辑回归来确定患者特征是否与 EHR 和注册表数据中吸烟状况的一致性有关。
我们分析了 11110 份患者记录。几乎所有（98%）患者的 EHR 吸烟状况都有记录。总体 Kappa（0.78；95%CI，0.77 至 0.79）表明登记处和 EHR 之间存在中度一致性。敏感性为 0.82（95%CI，0.81 至 0.84），特异性为 0.97（95%CI，0.96 至 0.97）。逻辑回归结果表明，年龄较大、女性以及 EHR 记录更接近癌症诊断日期的患者更有可能达成一致。
尽管记录癌症患者的吸烟状况是标准做法，但我们仅发现 EHR 和肿瘤登记数据之间存在中度一致性。使用 EHR 数据的干预和研究应优先确保吸烟状况数据的有效性。需要采取多层次策略，以实现癌症护理中吸烟状况的一致和准确记录。
