在电子健康记录数据中识别有问题的阿片类药物使用情况：我们是否找对了地方？
Identifying problematic opioid use in electronic health record data: Are we looking in the right place?
机构信息
Vanderbilt University School of Nursing, Nashville, Tennessee. ORCID: https://orcid.org/0000-0003-2551-019X.
Vanderbilt University, Blair School of Music, Nashville, Tennessee.
出版信息
J Opioid Manag. 2023 Jan-Feb;19(1):5-9. doi: 10.5055/jom.2023.0754.
OBJECTIVE
To examine the value of data obtained outside of regular healthcare visits (clinical communications) to detect problematic opioid use in electronic health records (EHRs).
DESIGN
A retrospective cohort study.
PARTICIPANTS
Chronic pain patient records in a large academic medical center.
INTERVENTIONS
We compared evidence for problematic opioid use in (1) clinic notes, (2) clinical communications, and (3) full EHR data. We analyzed keyword counts and calculated concordance and Cohen's κ between data sources.
MAIN OUTCOME MEASURE
Evidence of problematic opioid use in EHR defined as none, some, or high.
RESULTS
Twenty-six percent of records were discordant in determination of problematic opioid use between clinical communications and clinic notes. Of these, 54 percent detected more evidence in clinical communications, and 46 percent in clinic notes. Compared to full EHR review, clinic notes exhibited higher concordance (78 percent; κ = 0.619) than clinical communications (60 percent; κ = 0.290).
CONCLUSION
Clinical communications are a valuable addition to opioid EHR research.
目的
探讨在常规医疗就诊（临床交流）之外获取的数据在电子健康记录（EHR）中检测阿片类药物使用问题的价值。
设计
回顾性队列研究。
参与者
大型学术医疗中心的慢性疼痛患者记录。
干预措施
我们比较了（1）临床记录、（2）临床交流和（3）完整 EHR 数据中阿片类药物使用问题的证据。我们分析了关键词计数，并计算了数据源之间的一致性和 Cohen's κ。
主要观察指标
EHR 中阿片类药物使用问题的证据定义为无、有或高。
结果
在临床交流和临床记录中，有 26%的记录在确定阿片类药物使用问题上存在不一致。其中，54%在临床交流中检测到更多的证据，46%在临床记录中。与完整的 EHR 审查相比，临床记录的一致性更高（78%；κ=0.619），而临床交流的一致性较低（60%；κ=0.290）。
结论
临床交流是阿片类药物 EHR 研究的有价值的补充。
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