NPS MedicineWise, c/- Wexted Advisors, Level 17, 68 Pitt street, NSW 2000, Sydney, Australia.
National Drug and Alcohol Research Centre, UNSW Sydney, NSW 2052, Sydney, Australia.
Int J Popul Data Sci. 2023 Jan 24;6(1):2118. doi: 10.23889/ijpds.v8i1.2118. eCollection 2023.
Understanding the level of recording of acute serious events in general practice electronic health records (EHRs) is critical for making decisions about the suitability of general practice datasets to address research questions and requirements for linking general practice EHRs with other datasets.
To examine data source agreement of five serious acute events (myocardial infarction, stroke, venous thromboembolism (VTE), pancreatitis and suicide) recorded in general practice EHRs compared with hospital, emergency department (ED) and mortality data.
Data from 61 general practices routinely contributing data to the MedicineInsight database was linked with New South Wales administrative hospital, ED and mortality data. The study population comprised patients with at least three clinical encounters at participating general practices between 2019 and 2020 and at least one record in hospital, ED or mortality data between 2010 and 2020. Agreement was assessed between MedicineInsight diagnostic algorithms for the five events of interest and coded diagnoses in the administrative data. Dates of concordant events were compared.
The study included 274,420 general practice patients with at least one record in the administrative data between 2010 and 2020. Across the five acute events, specificity and NPV were excellent (>98%) but sensitivity (13%-51%) and PPV (30%-75%) were low. Sensitivity and PPV were highest for VTE (50.9%) and acute pancreatitis (75.2%), respectively. The majority (roughly 70-80%) of true positive cases were recorded in the EHR within 30 days of administrative records.
Large proportions of events identified from administrative data were not detected by diagnostic algorithms applied to general practice EHRs within the specific time period. EHR data extraction and study design only partly explain the low sensitivities/PPVs. Our findings support the use of Australian general practice EHRs linked to hospital, ED and mortality data for robust research on the selected serious acute conditions.
了解一般实践电子健康记录 (EHR) 中急性严重事件的记录水平对于做出关于一般实践数据集是否适合解决研究问题和满足将一般实践 EHR 与其他数据集链接的要求的决策至关重要。
比较五种严重急性事件（心肌梗死、中风、静脉血栓栓塞症 (VTE)、胰腺炎和自杀）在一般实践 EHR 中的记录与医院、急诊部 (ED) 和死亡率数据的数据源一致性。
将定期向 MedicineInsight 数据库提供数据的 61 家普通实践的数据与新南威尔士州的医院、ED 和死亡率数据进行了链接。研究人群包括 2019 年至 2020 年期间在参与的普通实践中至少有三次临床就诊，并且在 2010 年至 2020 年期间在医院、ED 或死亡率数据中至少有一条记录的患者。评估了 MedicineInsight 对五个感兴趣事件的诊断算法与行政数据中的编码诊断之间的一致性。比较了一致事件的日期。
这项研究包括了 274420 名至少在 2010 年至 2020 年期间在行政数据中记录了一项记录的普通实践患者。在这五个急性事件中，特异性和 NPV 非常高（>98%），但敏感性（13%-51%）和 PPV（30%-75%）较低。VTE（50.9%）和急性胰腺炎（75.2%）的敏感性和 PPV 最高。大多数（约 70-80%）真正的阳性病例在行政记录后的 30 天内被记录在 EHR 中。
从行政数据中确定的事件中有很大一部分没有被应用于一般实践 EHR 的诊断算法在特定时间段内检测到。EHR 数据提取和研究设计只能部分解释低敏感性/PPV。我们的发现支持使用澳大利亚一般实践 EHR 链接到医院、ED 和死亡率数据，以进行关于选定严重急性疾病的稳健研究。
