NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK
Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.
BMJ Open. 2022 Jul 25;12(7):e051456. doi: 10.1136/bmjopen-2021-051456.
To assess the diagnostic Read code usage for 18 conditions by examining their frequency and diversity in UK primary care between 2000 and 2013.
Population-based cohort study SETTING: 684 UK general practices contributing data to the Clinical Practice Research Datalink (CPRD) GOLD.
Patients with clinical codes for at least one of asthma, chronic obstructive pulmonary disease, diabetes, hypertension (HT), coronary heart disease, atrial fibrillation (AF), heart failure, stroke, hypothyroidism, chronic kidney disease, learning disability (LD), depression, dementia, epilepsy, severe mental illness (SMI), osteoarthritis, osteoporosis and cancer.
For the frequency ranking of clinical codes, canonical correlation analysis was applied to correlations of clinical code usage of 1, 3 and 5 years. Three measures of diversity (Shannon entropy index of diversity, richness and evenness) were used to quantify changes in incident and total clinical codes.
Overall, all examined conditions, except LD, showed positive monotonic correlation. HT, hypothyroidism, osteoarthritis and SMI codes' usage had high 5-year correlation. The codes' usage diversity remained stable overall throughout the study period. Cancer, diabetes and SMI had the highest richness (code lists need time to define) unlike AF, hypothyroidism and LD. SMI (high richness) and hypothyroidism (low richness) can last for 5 years, whereas cancer and diabetes (high richness) and LD (low richness) only last for 2 years.
This is an under-reported research area and the findings suggest the codes' usage diversity for most conditions remained overall stable throughout the study period. Generated mental health code lists can last for a long time unlike cardiometabolic conditions and cancer. Adopting more consistent and less diverse coding would help improve data quality in primary care. Future research is needed following the transfer to the Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) coding.
通过检查 2000 年至 2013 年英国初级保健中 18 种疾病的 Read 诊断代码使用频率和多样性，评估其诊断代码使用情况。
基于人群的队列研究
684 家向临床实践研究数据链接（CPRD）GOLD 提供数据的英国普通实践
至少有一个哮喘、慢性阻塞性肺疾病、糖尿病、高血压（HT）、冠心病、心房颤动（AF）、心力衰竭、中风、甲状腺功能减退、慢性肾脏病、学习障碍（LD）、抑郁症、痴呆、癫痫、严重精神疾病（SMI）、骨关节炎、骨质疏松症和癌症临床代码的患者。
对于临床代码的频率排名，应用典型相关分析对 1、3 和 5 年的临床代码使用相关性进行分析。使用三个多样性指标（多样性的香农熵指数、丰富度和均匀度）来量化新发病例和总临床代码的变化。
总体而言，除 LD 外，所有检查疾病均呈正单调相关。HT、甲状腺功能减退、骨关节炎和 SMI 代码的使用具有较高的 5 年相关性。整个研究期间，代码使用多样性总体保持稳定。癌症、糖尿病和 SMI 具有最高的丰富度（代码列表需要时间来定义），而 AF、甲状腺功能减退和 LD 则相反。SMI（高丰富度）和甲状腺功能减退症（低丰富度）可持续 5 年，而癌症和糖尿病（高丰富度）和 LD（低丰富度）仅可持续 2 年。
这是一个报道较少的研究领域，研究结果表明，在整个研究期间，大多数疾病的代码使用多样性总体保持稳定。与心脏代谢疾病和癌症相比，生成的心理健康代码列表可以持续很长时间。在初级保健中采用更一致和更少多样性的编码将有助于提高数据质量。需要在过渡到系统命名医学临床术语（SNOMED CT）编码后进行进一步的研究。
