Improved incidence estimates from linked vs. stand-alone electronic health records

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Objective

Electronic health records are widely used for public health research, and linked data sources are increasingly available. The added value of using linked records over stand-alone data has not been quantified for common conditions such as community-acquired pneumonia (CAP).

Study Design and Setting

Our cohort comprised English patients aged ≥65 years from the Clinical Practice Research Datalink, eligible for record linkage to Hospital Episode Statistics. Stand-alone general practice (GP) records were used to calculate CAP incidence over time using population-averaged Poisson regression. Incidence was then recalculated for the same patients using their linked GP-hospital admission data. Results of the two analyses were compared.

Results

Over 900,000 patients were included in each analysis. Population-averaged CAP incidence was 39% higher using the linked data than stand-alone data. This difference grew over time from 7% in 1997 to 83% by 2010. An increasingly larger number of pneumonia events were recorded in the hospital admission data compared to the GP data over time.

Conclusion

Use of primary or secondary care data in isolation may not give accurate incidence estimates for important infections in older populations. Further work is needed to establish the extent of this finding in other diseases, age groups, and populations.

Related collections

Most cited references 7

Record: found
Abstract: found
Article: not found

Recent advances in the utility and use of the General Practice Research Database as an example of a UK Primary Care Data resource.

Tim Williams, Tjeerd Van Staa, Shivani Puri … (2012)

Since its inception in the mid-1980s, the General Practice Research Database (GPRD) has undergone many changes but remains the largest validated and most utilised primary care database in the UK. Its use in pharmacoepidemiology stretches back many years with now over 800 original research papers. Administered by the Medicines and Healthcare products Regulatory Agency since 2001, the last 5 years have seen a rebuild of the database processing system enhancing access to the data, and a concomitant push towards broadening the applications of the database. New methodologies including real-world harm-benefit assessment, pharmacogenetic studies and pragmatic randomised controlled trials within the database are being implemented. A substantive and unique linkage program (using a trusted third party) has enabled access to secondary care data and disease-specific registry data as well as socio-economic data and death registration data. The utility of anonymised free text accessed in a safe and appropriate manner is being explored using simple and more complex techniques such as natural language processing.

0 comments Cited 147 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

General practitioners' contribution to the management of community-acquired pneumonia in the Netherlands: a retrospective analysis of primary care, hospital, and national mortality databases with individual data linkage

Bianca EP Snijders, Wim van der Hoek, Irina Stirbu … (2013)

Background: Community-acquired pneumonia (CAP) is an important cause of hospital admission and death, but the extent of the problem of CAP at the primary healthcare level is largely unknown. Aims: To investigate the contribution of general practitioners (GPs) to the management of patients with CAP in the Netherlands. Methods: The study population consisted of all people enlisted in a GP network. We obtained information on CAP episodes from GP electronic records (using ICPC code R81) during the years 2002–2009. CAP registrations were also obtained from national hospital discharge data (ICD-9 codes) and cause of death statistics (ICD-10 codes). The three registration systems were linked at the individual level. We used descriptive analyses to estimate the annual number of CAP episodes (i.e. defined as a CAP diagnosis within 30 days). Results: From 2002 to 2009 the mean annual size of the study population was 395,039. For this population, 3,700 (0.9%) CAP episodes per year were registered in at least one of the registration systems, 2,933 (79%) of which were in the GP system only. Recovery within 30 days occurred on average in 95% (2,791/2,933) of the CAP episodes annually registered by a GP, while 2.3% (67/2,933) of patients with a GP-registered CAP episode were admitted to hospital within 30 days and 1% (26/2,933) had a fatal outcome within 30 days. Conclusions: The vast majority of CAP episodes registered in the Netherlands are managed successfully at the GP level without hospitalisation.

0 comments Cited 15 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Defining upper gastrointestinal bleeding from linked primary and secondary care data and the effect on occurrence and 28 day mortality

Colin Crooks, Timothy Richard Card, Joe West (2012)

Background Primary care records from the UK have frequently been used to identify episodes of upper gastrointestinal bleeding in studies of drug toxicity because of their comprehensive population coverage and longitudinal recording of prescriptions and diagnoses. Recent linkage within England of primary and secondary care data has augmented this data but the timing and coding of concurrent events, and how the definition of events in linked data effects occurrence and 28 day mortality is not known. Methods We used the recently linked English Hospital Episodes Statistics and General Practice Research Database, 1997–2010, to define events by; a specific upper gastrointestinal bleed code in either dataset, a specific bleed code in both datasets, or a less specific but plausible code from the linked dataset. Results This approach resulted in 81% of secondary care defined bleeds having a corresponding plausible code within 2 months in primary care. However only 62% of primary care defined bleeds had a corresponding plausible HES admission within 2 months. The more restrictive and specific case definitions excluded severe events and almost halved the 28 day case fatality when compared to broader and more sensitive definitions. Conclusions Restrictive definitions of gastrointestinal bleeding in linked datasets fail to capture the full heterogeneity in coding possible following complex clinical events. Conversely too broad a definition in primary care introduces events not severe enough to warrant hospital admission. Ignoring these issues may unwittingly introduce selection bias into a study’s results.

0 comments Cited 14 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Elizabeth R.C. Millett

Journal

Journal ID (nlm-ta): J Clin Epidemiol

Journal ID (iso-abbrev): J Clin Epidemiol

Title: Journal of Clinical Epidemiology

Publisher: Elsevier

ISSN (Print): 0895-4356

ISSN (Electronic): 1878-5921

Publication date PMC-release: 1 July 2016

Publication date (Print): July 2016

Volume: 75

Pages: 66-69

Affiliations

[a ]Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

[b ]Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

[c ]Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

Author notes

[∗ ]Corresponding author. Tel.: +0044 1865 612911. elizabeth.millett@ 123456ndm.ox.ac.uk

Article

Publisher ID: S0895-4356(16)00013-5

DOI: 10.1016/j.jclinepi.2016.01.005

PMC ID: 4922622

PubMed ID: 26776084

SO-VID: 2f11ebb0-6ec6-4acd-9928-a2dcab20ef0f

License:

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

History

Date accepted : 4 January 2016

Comments

Comment on this article

scite_

Smart Citations

Citing PublicationsSupportingMentioningContrasting

View Citations

See how this article has been cited at scite.ai

scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

Improved incidence estimates from linked vs. stand-alone electronic health records

Read this article at

Abstract

Objective

Study Design and Setting

Results

Conclusion

Related collections

Jiangsu Journal of Preventive Medicine

Most cited references 7

Recent advances in the utility and use of the General Practice Research Database as an example of a UK Primary Care Data resource.

General practitioners' contribution to the management of community-acquired pneumonia in the Netherlands: a retrospective analysis of primary care, hospital, and national mortality databases with individual data linkage

Defining upper gastrointestinal bleeding from linked primary and secondary care data and the effect on occurrence and 28 day mortality

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 157

Cited by 23

Most referenced authors 382