Cargando…
Validation of the recording of idiopathic pulmonary fibrosis in routinely collected electronic healthcare records in England
BACKGROUND: Routinely-collected healthcare data provide a valuable resource for epidemiological research. Validation studies have shown that for most conditions, simple lists of clinical codes can reliably be used for case finding in primary care, however, studies exploring the robustness of this ap...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10337174/ https://www.ncbi.nlm.nih.gov/pubmed/37434192 http://dx.doi.org/10.1186/s12890-023-02550-0 |
_version_ | 1785071362422865920 |
---|---|
author | Morgan, Ann Gupta, Rikisha Shah George, Peter M. Quint, Jennifer K. |
author_facet | Morgan, Ann Gupta, Rikisha Shah George, Peter M. Quint, Jennifer K. |
author_sort | Morgan, Ann |
collection | PubMed |
description | BACKGROUND: Routinely-collected healthcare data provide a valuable resource for epidemiological research. Validation studies have shown that for most conditions, simple lists of clinical codes can reliably be used for case finding in primary care, however, studies exploring the robustness of this approach are lacking for diseases such as idiopathic pulmonary fibrosis (IPF) which are largely managed in secondary care. METHOD: Using the UK’s Clinical Practice Research Datalink (CPRD) Aurum dataset, which comprises patient-level primary care records linked to national hospital admissions and cause-of-death data, we compared the positive predictive value (PPV) of eight diagnostic algorithms. Algorithms were developed based on the literature and IPF diagnostic guidelines using combinations of clinical codes in primary and secondary care (SNOMED-CT or ICD-10) with/without additional information. The positive predictive value (PPV) was estimated for each algorithm using the death record as the gold standard. Utilization of the reviewed codes across the study period was observed to evaluate any change in coding practices over time. RESULT: A total of 17,559 individuals had a least one record indicative of IPF in one or more of our three linked datasets between 2008 and 2018. The PPV of case-finding algorithms based on clinical codes alone ranged from 64.4% (95%CI:63.3–65.3) for a “broad” codeset to 74.9% (95%CI:72.8–76.9) for a “narrow” codeset comprising highly-specific codes. Adding confirmatory evidence, such as a CT scan, increased the PPV of our narrow code-based algorithm to 79.2% (95%CI:76.4–81.8) but reduced the sensitivity to under 10%. Adding evidence of hospitalisation to the standalone code-based algorithms also improved PPV, (PPV = 78.4 vs. 64.4%; sensitivity = 53.5% vs. 38.1%). IPF coding practices changed over time, with the increased use of specific IPF codes. CONCLUSION: High diagnostic validity was achieved by using a restricted set of IPF codes. While adding confirmatory evidence increased diagnostic accuracy, the benefits of this approach need to be weighed against the inevitable loss of sample size and convenience. We would recommend use of an algorithm based on a broader IPF code set coupled with evidence of hospitalisation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-023-02550-0. |
format | Online Article Text |
id | pubmed-10337174 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-103371742023-07-13 Validation of the recording of idiopathic pulmonary fibrosis in routinely collected electronic healthcare records in England Morgan, Ann Gupta, Rikisha Shah George, Peter M. Quint, Jennifer K. BMC Pulm Med Research BACKGROUND: Routinely-collected healthcare data provide a valuable resource for epidemiological research. Validation studies have shown that for most conditions, simple lists of clinical codes can reliably be used for case finding in primary care, however, studies exploring the robustness of this approach are lacking for diseases such as idiopathic pulmonary fibrosis (IPF) which are largely managed in secondary care. METHOD: Using the UK’s Clinical Practice Research Datalink (CPRD) Aurum dataset, which comprises patient-level primary care records linked to national hospital admissions and cause-of-death data, we compared the positive predictive value (PPV) of eight diagnostic algorithms. Algorithms were developed based on the literature and IPF diagnostic guidelines using combinations of clinical codes in primary and secondary care (SNOMED-CT or ICD-10) with/without additional information. The positive predictive value (PPV) was estimated for each algorithm using the death record as the gold standard. Utilization of the reviewed codes across the study period was observed to evaluate any change in coding practices over time. RESULT: A total of 17,559 individuals had a least one record indicative of IPF in one or more of our three linked datasets between 2008 and 2018. The PPV of case-finding algorithms based on clinical codes alone ranged from 64.4% (95%CI:63.3–65.3) for a “broad” codeset to 74.9% (95%CI:72.8–76.9) for a “narrow” codeset comprising highly-specific codes. Adding confirmatory evidence, such as a CT scan, increased the PPV of our narrow code-based algorithm to 79.2% (95%CI:76.4–81.8) but reduced the sensitivity to under 10%. Adding evidence of hospitalisation to the standalone code-based algorithms also improved PPV, (PPV = 78.4 vs. 64.4%; sensitivity = 53.5% vs. 38.1%). IPF coding practices changed over time, with the increased use of specific IPF codes. CONCLUSION: High diagnostic validity was achieved by using a restricted set of IPF codes. While adding confirmatory evidence increased diagnostic accuracy, the benefits of this approach need to be weighed against the inevitable loss of sample size and convenience. We would recommend use of an algorithm based on a broader IPF code set coupled with evidence of hospitalisation. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12890-023-02550-0. BioMed Central 2023-07-11 /pmc/articles/PMC10337174/ /pubmed/37434192 http://dx.doi.org/10.1186/s12890-023-02550-0 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Morgan, Ann Gupta, Rikisha Shah George, Peter M. Quint, Jennifer K. Validation of the recording of idiopathic pulmonary fibrosis in routinely collected electronic healthcare records in England |
title | Validation of the recording of idiopathic pulmonary fibrosis in routinely collected electronic healthcare records in England |
title_full | Validation of the recording of idiopathic pulmonary fibrosis in routinely collected electronic healthcare records in England |
title_fullStr | Validation of the recording of idiopathic pulmonary fibrosis in routinely collected electronic healthcare records in England |
title_full_unstemmed | Validation of the recording of idiopathic pulmonary fibrosis in routinely collected electronic healthcare records in England |
title_short | Validation of the recording of idiopathic pulmonary fibrosis in routinely collected electronic healthcare records in England |
title_sort | validation of the recording of idiopathic pulmonary fibrosis in routinely collected electronic healthcare records in england |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10337174/ https://www.ncbi.nlm.nih.gov/pubmed/37434192 http://dx.doi.org/10.1186/s12890-023-02550-0 |
work_keys_str_mv | AT morganann validationoftherecordingofidiopathicpulmonaryfibrosisinroutinelycollectedelectronichealthcarerecordsinengland AT guptarikishashah validationoftherecordingofidiopathicpulmonaryfibrosisinroutinelycollectedelectronichealthcarerecordsinengland AT georgepeterm validationoftherecordingofidiopathicpulmonaryfibrosisinroutinelycollectedelectronichealthcarerecordsinengland AT quintjenniferk validationoftherecordingofidiopathicpulmonaryfibrosisinroutinelycollectedelectronichealthcarerecordsinengland |