Validation of the Recording of Acute Exacerbations of COPD in UK Primary Care Electronic Healthcare Records
Acute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform healthcare utilisation and service provision. However, there is no standardised method of identifying AECOPD in UK EHR. We aimed to validate the recording...
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| Published in | PloS one Vol. 11; no. 3; p. e0151357 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Public Library of Science
09.03.2016
Public Library of Science (PLoS) |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1932-6203 1932-6203 |
| DOI | 10.1371/journal.pone.0151357 |
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| Abstract | Acute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform healthcare utilisation and service provision. However, there is no standardised method of identifying AECOPD in UK EHR. We aimed to validate the recording of AECOPD in UK EHR.
We randomly selected 1385 patients with COPD from the Clinical Practice Research Datalink. We selected dates of possible AECOPD based on 15 different algorithms between January 2004 and August 2013. Questionnaires were sent to GPs asking for confirmation of their patients' AECOPD on the dates identified and for any additional relevant information. Responses were reviewed independently by two respiratory physicians. Positive predictive value (PPV) and sensitivity were calculated.
The response rate was 71.3%. AECOPD diagnostic codes, lower respiratory tract infection (LRTI) codes, and prescriptions of antibiotics and oral corticosteroids (OCS) together for 5-14 days had a high PPV (>75%) for identifying AECOPD. Symptom-based algorithms and prescription of antibiotics or OCS alone had lower PPVs (60-75%). A combined strategy of antibiotic and OCS prescriptions for 5-14 days, or LRTI or AECOPD code resulted in a PPV of 85.5% (95% CI, 82.7-88.3%) and a sensitivity of 62.9% (55.4-70.4%).
Using a combination of diagnostic and therapy codes, the validity of AECOPD identified from EHR can be high. These strategies are useful for understanding health-care utilisation for AECOPD, informing service provision and for researchers. These results highlight the need for common coding strategies to be adopted in primary care to allow easy and accurate identification of events. |
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| AbstractList | Background Acute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform healthcare utilisation and service provision. However, there is no standardised method of identifying AECOPD in UK EHR. We aimed to validate the recording of AECOPD in UK EHR. Methods We randomly selected 1385 patients with COPD from the Clinical Practice Research Datalink. We selected dates of possible AECOPD based on 15 different algorithms between January 2004 and August 2013. Questionnaires were sent to GPs asking for confirmation of their patients' AECOPD on the dates identified and for any additional relevant information. Responses were reviewed independently by two respiratory physicians. Positive predictive value (PPV) and sensitivity were calculated. Results The response rate was 71.3%. AECOPD diagnostic codes, lower respiratory tract infection (LRTI) codes, and prescriptions of antibiotics and oral corticosteroids (OCS) together for 5-14 days had a high PPV (>75%) for identifying AECOPD. Symptom-based algorithms and prescription of antibiotics or OCS alone had lower PPVs (60-75%). A combined strategy of antibiotic and OCS prescriptions for 5-14 days, or LRTI or AECOPD code resulted in a PPV of 85.5% (95% CI, 82.7-88.3%) and a sensitivity of 62.9% (55.4-70.4%). Conclusion Using a combination of diagnostic and therapy codes, the validity of AECOPD identified from EHR can be high. These strategies are useful for understanding health-care utilisation for AECOPD, informing service provision and for researchers. These results highlight the need for common coding strategies to be adopted in primary care to allow easy and accurate identification of events. Acute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform healthcare utilisation and service provision. However, there is no standardised method of identifying AECOPD in UK EHR. We aimed to validate the recording of AECOPD in UK EHR. We randomly selected 1385 patients with COPD from the Clinical Practice Research Datalink. We selected dates of possible AECOPD based on 15 different algorithms between January 2004 and August 2013. Questionnaires were sent to GPs asking for confirmation of their patients' AECOPD on the dates identified and for any additional relevant information. Responses were reviewed independently by two respiratory physicians. Positive predictive value (PPV) and sensitivity were calculated. The response rate was 71.3%. AECOPD diagnostic codes, lower respiratory tract infection (LRTI) codes, and prescriptions of antibiotics and oral corticosteroids (OCS) together for 5-14 days had a high PPV (>75%) for identifying AECOPD. Symptom-based algorithms and prescription of antibiotics or OCS alone had lower PPVs (60-75%). A combined strategy of antibiotic and OCS prescriptions for 5-14 days, or LRTI or AECOPD code resulted in a PPV of 85.5% (95% CI, 82.7-88.3%) and a sensitivity of 62.9% (55.4-70.4%). Using a combination of diagnostic and therapy codes, the validity of AECOPD identified from EHR can be high. These strategies are useful for understanding health-care utilisation for AECOPD, informing service provision and for researchers. These results highlight the need for common coding strategies to be adopted in primary care to allow easy and accurate identification of events. BackgroundAcute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform healthcare utilisation and service provision. However, there is no standardised method of identifying AECOPD in UK EHR. We aimed to validate the recording of AECOPD in UK EHR.MethodsWe randomly selected 1385 patients with COPD from the Clinical Practice Research Datalink. We selected dates of possible AECOPD based on 15 different algorithms between January 2004 and August 2013. Questionnaires were sent to GPs asking for confirmation of their patients' AECOPD on the dates identified and for any additional relevant information. Responses were reviewed independently by two respiratory physicians. Positive predictive value (PPV) and sensitivity were calculated.ResultsThe response rate was 71.3%. AECOPD diagnostic codes, lower respiratory tract infection (LRTI) codes, and prescriptions of antibiotics and oral corticosteroids (OCS) together for 5-14 days had a high PPV (>75%) for identifying AECOPD. Symptom-based algorithms and prescription of antibiotics or OCS alone had lower PPVs (60-75%). A combined strategy of antibiotic and OCS prescriptions for 5-14 days, or LRTI or AECOPD code resulted in a PPV of 85.5% (95% CI, 82.7-88.3%) and a sensitivity of 62.9% (55.4-70.4%).ConclusionUsing a combination of diagnostic and therapy codes, the validity of AECOPD identified from EHR can be high. These strategies are useful for understanding health-care utilisation for AECOPD, informing service provision and for researchers. These results highlight the need for common coding strategies to be adopted in primary care to allow easy and accurate identification of events. Acute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform healthcare utilisation and service provision. However, there is no standardised method of identifying AECOPD in UK EHR. We aimed to validate the recording of AECOPD in UK EHR. We randomly selected 1385 patients with COPD from the Clinical Practice Research Datalink. We selected dates of possible AECOPD based on 15 different algorithms between January 2004 and August 2013. Questionnaires were sent to GPs asking for confirmation of their patients' AECOPD on the dates identified and for any additional relevant information. Responses were reviewed independently by two respiratory physicians. Positive predictive value (PPV) and sensitivity were calculated. The response rate was 71.3%. AECOPD diagnostic codes, lower respiratory tract infection (LRTI) codes, and prescriptions of antibiotics and oral corticosteroids (OCS) together for 5-14 days had a high PPV (>75%) for identifying AECOPD. Symptom-based algorithms and prescription of antibiotics or OCS alone had lower PPVs (60-75%). A combined strategy of antibiotic and OCS prescriptions for 5-14 days, or LRTI or AECOPD code resulted in a PPV of 85.5% (95% CI, 82.7-88.3%) and a sensitivity of 62.9% (55.4-70.4%). Using a combination of diagnostic and therapy codes, the validity of AECOPD identified from EHR can be high. These strategies are useful for understanding health-care utilisation for AECOPD, informing service provision and for researchers. These results highlight the need for common coding strategies to be adopted in primary care to allow easy and accurate identification of events. Acute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform healthcare utilisation and service provision. However, there is no standardised method of identifying AECOPD in UK EHR. We aimed to validate the recording of AECOPD in UK EHR.BACKGROUNDAcute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform healthcare utilisation and service provision. However, there is no standardised method of identifying AECOPD in UK EHR. We aimed to validate the recording of AECOPD in UK EHR.We randomly selected 1385 patients with COPD from the Clinical Practice Research Datalink. We selected dates of possible AECOPD based on 15 different algorithms between January 2004 and August 2013. Questionnaires were sent to GPs asking for confirmation of their patients' AECOPD on the dates identified and for any additional relevant information. Responses were reviewed independently by two respiratory physicians. Positive predictive value (PPV) and sensitivity were calculated.METHODSWe randomly selected 1385 patients with COPD from the Clinical Practice Research Datalink. We selected dates of possible AECOPD based on 15 different algorithms between January 2004 and August 2013. Questionnaires were sent to GPs asking for confirmation of their patients' AECOPD on the dates identified and for any additional relevant information. Responses were reviewed independently by two respiratory physicians. Positive predictive value (PPV) and sensitivity were calculated.The response rate was 71.3%. AECOPD diagnostic codes, lower respiratory tract infection (LRTI) codes, and prescriptions of antibiotics and oral corticosteroids (OCS) together for 5-14 days had a high PPV (>75%) for identifying AECOPD. Symptom-based algorithms and prescription of antibiotics or OCS alone had lower PPVs (60-75%). A combined strategy of antibiotic and OCS prescriptions for 5-14 days, or LRTI or AECOPD code resulted in a PPV of 85.5% (95% CI, 82.7-88.3%) and a sensitivity of 62.9% (55.4-70.4%).RESULTSThe response rate was 71.3%. AECOPD diagnostic codes, lower respiratory tract infection (LRTI) codes, and prescriptions of antibiotics and oral corticosteroids (OCS) together for 5-14 days had a high PPV (>75%) for identifying AECOPD. Symptom-based algorithms and prescription of antibiotics or OCS alone had lower PPVs (60-75%). A combined strategy of antibiotic and OCS prescriptions for 5-14 days, or LRTI or AECOPD code resulted in a PPV of 85.5% (95% CI, 82.7-88.3%) and a sensitivity of 62.9% (55.4-70.4%).Using a combination of diagnostic and therapy codes, the validity of AECOPD identified from EHR can be high. These strategies are useful for understanding health-care utilisation for AECOPD, informing service provision and for researchers. These results highlight the need for common coding strategies to be adopted in primary care to allow easy and accurate identification of events.CONCLUSIONUsing a combination of diagnostic and therapy codes, the validity of AECOPD identified from EHR can be high. These strategies are useful for understanding health-care utilisation for AECOPD, informing service provision and for researchers. These results highlight the need for common coding strategies to be adopted in primary care to allow easy and accurate identification of events. Background Acute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform healthcare utilisation and service provision. However, there is no standardised method of identifying AECOPD in UK EHR. We aimed to validate the recording of AECOPD in UK EHR. Methods We randomly selected 1385 patients with COPD from the Clinical Practice Research Datalink. We selected dates of possible AECOPD based on 15 different algorithms between January 2004 and August 2013. Questionnaires were sent to GPs asking for confirmation of their patients’ AECOPD on the dates identified and for any additional relevant information. Responses were reviewed independently by two respiratory physicians. Positive predictive value (PPV) and sensitivity were calculated. Results The response rate was 71.3%. AECOPD diagnostic codes, lower respiratory tract infection (LRTI) codes, and prescriptions of antibiotics and oral corticosteroids (OCS) together for 5–14 days had a high PPV (>75%) for identifying AECOPD. Symptom-based algorithms and prescription of antibiotics or OCS alone had lower PPVs (60–75%). A combined strategy of antibiotic and OCS prescriptions for 5–14 days, or LRTI or AECOPD code resulted in a PPV of 85.5% (95% CI, 82.7–88.3%) and a sensitivity of 62.9% (55.4–70.4%). Conclusion Using a combination of diagnostic and therapy codes, the validity of AECOPD identified from EHR can be high. These strategies are useful for understanding health-care utilisation for AECOPD, informing service provision and for researchers. These results highlight the need for common coding strategies to be adopted in primary care to allow easy and accurate identification of events. |
| Audience | Academic |
| Author | Quint, Jennifer K. Smeeth, Liam Thomas, Sara L. Rothnie, Kieran J. Müllerová, Hana Hurst, John R. Davis, Kourtney |
| AuthorAffiliation | 1 Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom 4 UCL Respiratory Medicine, University College London, London, United Kingdom 5 Respiratory Epidemiology, GSK R&D, Collegeville, PA, United States of America Lee Kong Chian School of Medicine, SINGAPORE 3 Respiratory Epidemiology, GSK R&D, Uxbridge, United Kingdom 2 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom |
| AuthorAffiliation_xml | – name: 2 Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom – name: 4 UCL Respiratory Medicine, University College London, London, United Kingdom – name: Lee Kong Chian School of Medicine, SINGAPORE – name: 3 Respiratory Epidemiology, GSK R&D, Uxbridge, United Kingdom – name: 5 Respiratory Epidemiology, GSK R&D, Collegeville, PA, United States of America – name: 1 Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom |
| Author_xml | – sequence: 1 givenname: Kieran J. surname: Rothnie fullname: Rothnie, Kieran J. – sequence: 2 givenname: Hana surname: Müllerová fullname: Müllerová, Hana – sequence: 3 givenname: John R. surname: Hurst fullname: Hurst, John R. – sequence: 4 givenname: Liam surname: Smeeth fullname: Smeeth, Liam – sequence: 5 givenname: Kourtney surname: Davis fullname: Davis, Kourtney – sequence: 6 givenname: Sara L. surname: Thomas fullname: Thomas, Sara L. – sequence: 7 givenname: Jennifer K. surname: Quint fullname: Quint, Jennifer K. |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/26959820$$D View this record in MEDLINE/PubMed |
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| ContentType | Journal Article |
| Copyright | COPYRIGHT 2016 Public Library of Science 2016 Rothnie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2016 Rothnie et al 2016 Rothnie et al |
| Copyright_xml | – notice: COPYRIGHT 2016 Public Library of Science – notice: 2016 Rothnie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: 2016 Rothnie et al 2016 Rothnie et al |
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| DOI | 10.1371/journal.pone.0151357 |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Competing Interests: We have the following interests. This study was partly supported by a GlaxoSmithKline and Medical Research Council (MRC) industry partnership award. Hana Müllerová and Kourtney Davis are employed by GSK and hold stock and share options of GlaxoSmithKline Plc. JKQ reports grants from MRC, grants from GSK, during the conduct of the study; grants from MRC, grants from BLF, personal fees from AZ, personal fees from GSK, grants from Wellcome Trust, outside the submitted work. JRH reports personal fees from Pharmaceutical companies interested in COPD including AZ, Chiesi, GSK, Novartis, Pfizer, Takeda, outside the submitted work. Imperial College of Science, Technology and Medicine. LS reports grants from Wellcome Trust, during the conduct of the study; grants from Wellcome Trust, grants from MRC, grants from NIHR, personal fees from GSK, outside the submitted work. There are no patents, products in development or marketed products to declare. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors. Conceived and designed the experiments: KJR HM LS KD SLT JKQ. Performed the experiments: KJR JRH JKQ. Analyzed the data: KJR HM JKQ. Contributed reagents/materials/analysis tools: KJR HM JRH LS KD SLT JKQ. Wrote the paper: KJR HM JRH LS KD SLT JKQ. |
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| References | M Miravitlles (ref4) 2004; 59 ref14 (ref5) 2006 R Lozano (ref1) 2012; 380 JA Wedzicha (ref9) 2004; 1 SAJ Schmidt (ref3) 2014; 4 H Müllerová (ref6) 2014; 4 JK Quint (ref11) 2014; 4 S Suissa (ref2) 2012; 67 GC Donaldson (ref7) 2010; 137 C Stenton (ref13) 2008; 58 KF Rabe (ref12) 2007; 176 E Herrett (ref10) 2015 J Griffin (ref8) 2008; 17 |
| References_xml | – volume: 380 start-page: 2095 issue: 9859 year: 2012 ident: ref1 article-title: Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 publication-title: The Lancet doi: 10.1016/S0140-6736(12)61728-0 – volume: 58 start-page: 226 issue: 3 year: 2008 ident: ref13 article-title: The MRC breathlessness scale publication-title: Occupational Medicine doi: 10.1093/occmed/kqm162 – volume: 1 start-page: 115 issue: 2 year: 2004 ident: ref9 article-title: Role of Viruses in Exacerbations of Chronic Obstructive Pulmonary Disease publication-title: Proceedings of the American Thoracic Society doi: 10.1513/pats.2306030 – volume: 137 start-page: 1091 issue: 5 year: 2010 ident: ref7 article-title: Increased risk of myocardial infarction and stroke following exacerbation of copd publication-title: Chest doi: 10.1378/chest.09-2029 – volume: 17 start-page: 104 year: 2008 ident: ref8 article-title: Comparison of tiotropium bromide and combined ipratropium/salbutamol for the treatment of COPD: a UK General Practice Research Database 12-month follow-up study publication-title: Primary Care Respiratory Journal doi: 10.3132/pcrj.2008.00024 – volume: 4 issue: 12 year: 2014 ident: ref3 article-title: The impact of exacerbation frequency on mortality following acute exacerbations of COPD: a registry-based cohort study publication-title: BMJ Open – volume: 4 issue: 7 year: 2014 ident: ref11 article-title: Validation of chronic obstructive pulmonary disease recording in the Clinical Practice Research Datalink (CPRD-GOLD) publication-title: BMJ Open doi: 10.1136/bmjopen-2014-005540 – year: 2006 ident: ref5 article-title: Clearing the Air: A national study of chronic obstructive pulmonary disease – volume: 176 start-page: 532 issue: 6 year: 2007 ident: ref12 article-title: Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease publication-title: American Journal of Respiratory and Critical Care Medicine doi: 10.1164/rccm.200703-456SO – volume: 4 issue: 12 year: 2014 ident: ref6 article-title: Risk factors for acute exacerbations of COPD in a primary care population: a retrospective observational cohort study publication-title: BMJ Open doi: 10.1136/bmjopen-2014-006171 – volume: 67 start-page: 957 issue: 11 year: 2012 ident: ref2 article-title: Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality publication-title: Thorax doi: 10.1136/thoraxjnl-2011-201518 – volume: 59 start-page: 387 issue: 5 year: 2004 ident: ref4 article-title: Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study publication-title: Thorax doi: 10.1136/thx.2003.008730 – year: 2015 ident: ref10 article-title: Data Resource Profile: Clinical Practice Research Datalink (CPRD) publication-title: International Journal of Epidemiology – ident: ref14 |
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| Snippet | Acute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform healthcare... Background Acute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform... BackgroundAcute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform... Background Acute Exacerbations of COPD (AECOPD) identified from electronic healthcare records (EHR) are important for research, public health and to inform... |
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| Title | Validation of the Recording of Acute Exacerbations of COPD in UK Primary Care Electronic Healthcare Records |
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