Validation of chronic obstructive pulmonary disease recording in the Clinical Practice Research Datalink (CPRD-GOLD)

• Published in: BMJ open Vol. 4; no. 7; p. e005540
• Main Authors: Quint, Jennifer K, Müllerova, Hana, DiSantostefano, Rachael L, Forbes, Harriet, Eaton, Susan, Hurst, John R, Davis, Kourtney, Smeeth, Liam
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 01.07.2014; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Accuracy; Aged; Algorithms; Biomedical Research; Bronchitis; Chronic obstructive pulmonary disease; Clinical medicine; Codes; Databases, Factual; Electronic Health Records; Female; Humans; Lung diseases; Male; Medical coding; Medical records; Middle Aged; Patients; Practice research; Primary care; Primary Health Care; Pulmonary Disease, Chronic Obstructive; Questionnaires; Respiratory Medicine; RESPIRATORY MEDICINE (see Thoracic Medicine); Response rates; Software; Spirometry; THORACIC MEDICINE; United Kingdom > UK; THORACIC MEDICINE; RESPIRATORY MEDICINE (see Thoracic Medicine)
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2014-005540

Objectives The optimal method of identifying people with chronic obstructive pulmonary disease (COPD) from electronic primary care records is not known. We assessed the accuracy of different approaches using the Clinical Practice Research Datalink, a UK electronic health record database. Setting 951 participants registered with a CPRD practice in the UK between 1 January 2004 and 31 December 2012. Individuals were selected for ≥1 of 8 algorithms to identify people with COPD. General practitioners were sent a brief questionnaire and additional evidence to support a COPD diagnosis was requested. All information received was reviewed independently by two respiratory physicians whose opinion was taken as the gold standard. Primary outcome measure The primary measure of accuracy was the positive predictive value (PPV), the proportion of people identified by each algorithm for whom COPD was confirmed. Results 951 questionnaires were sent and 738 (78%) returned. After quality control, 696 (73.2%) patients were included in the final analysis. All four algorithms including a specific COPD diagnostic code performed well. Using a diagnostic code alone, the PPV was 86.5% (77.5–92.3%) while requiring a diagnosis plus spirometry plus specific medication; the PPV was slightly higher at 89.4% (80.7–94.5%) but reduced case numbers by 10%. Algorithms without specific diagnostic codes had low PPVs (range 12.2–44.4%). Conclusions Patients with COPD can be accurately identified from UK primary care records using specific diagnostic codes. Requiring spirometry or COPD medications only marginally improved accuracy. The high accuracy applies since the introduction of an incentivised disease register for COPD as part of Quality and Outcomes Framework in 2004.