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Identifying Asthma Exacerbation-Related Emergency Department Visit Using Electronic Medical Record and Claims Data

Background  Asthma exacerbation leading to emergency department (ED) visit is prevalent, an indicator of poor control of asthma, and is a potentially preventable clinical outcome. Objective  We propose to utilize multiple data elements available in electronic medical records (EMRs) and claims databa...

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Autores principales: Sundaresan, Agnes S., Schneider, Gargi, Reynolds, Joy, Kirchner, H. Lester
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2018
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051766/
https://www.ncbi.nlm.nih.gov/pubmed/30040112
http://dx.doi.org/10.1055/s-0038-1666994
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author Sundaresan, Agnes S.
Schneider, Gargi
Reynolds, Joy
Kirchner, H. Lester
author_facet Sundaresan, Agnes S.
Schneider, Gargi
Reynolds, Joy
Kirchner, H. Lester
author_sort Sundaresan, Agnes S.
collection PubMed
description Background  Asthma exacerbation leading to emergency department (ED) visit is prevalent, an indicator of poor control of asthma, and is a potentially preventable clinical outcome. Objective  We propose to utilize multiple data elements available in electronic medical records (EMRs) and claims database to create separate algorithms with high validity for clinical and research purposes to identify asthma exacerbation-related ED visit among the general population. Methods  We performed a retrospective study with inclusion criteria of patients aged 4 to 40 years, a visit to Geisinger ED from January 1, 2006, to October 28, 2013, with asthma on their problem list. Different electronic data elements including chief complaints, vitals, season, smoking, medication use, and discharge diagnoses were obtained to create the algorithm. A stratified random sample was generated to select the charts for review. Chart review was performed to classify patients with asthma-related ED visit, that is, the gold standard. Two reviewers performed the chart review and validation was done on a small subset. Results  There were 966 eligible ED visits in the EMR sample and 731 in the claims sample. Agreement between reviewers was 95.45% and kappa statistic was 0.91. Mean age of the EMR sample was 22 years, and mostly white (93%). Multiple models conventionally used in studies were evaluated and the final model chosen included principal diagnosis, bronchodilator, and steroid use for both algorithms, chief complaints for EMR, and secondary diagnosis for claims. Area under the curve was 0.93 (95% confidence interval: 0.91–0.94) and 0.94 (0.93–0.96), respectively, for EMR and claims data, with positive predictive value of > 94%. The algorithms are visually presented using nomograms. Conclusion  We were able to develop two separate algorithms for EMR and claims to identify asthma exacerbation-related ED visit with excellent diagnostic ability and varying discrimination threshold for clinical and research purposes.
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spelling pubmed-60517662019-07-01 Identifying Asthma Exacerbation-Related Emergency Department Visit Using Electronic Medical Record and Claims Data Sundaresan, Agnes S. Schneider, Gargi Reynolds, Joy Kirchner, H. Lester Appl Clin Inform Background  Asthma exacerbation leading to emergency department (ED) visit is prevalent, an indicator of poor control of asthma, and is a potentially preventable clinical outcome. Objective  We propose to utilize multiple data elements available in electronic medical records (EMRs) and claims database to create separate algorithms with high validity for clinical and research purposes to identify asthma exacerbation-related ED visit among the general population. Methods  We performed a retrospective study with inclusion criteria of patients aged 4 to 40 years, a visit to Geisinger ED from January 1, 2006, to October 28, 2013, with asthma on their problem list. Different electronic data elements including chief complaints, vitals, season, smoking, medication use, and discharge diagnoses were obtained to create the algorithm. A stratified random sample was generated to select the charts for review. Chart review was performed to classify patients with asthma-related ED visit, that is, the gold standard. Two reviewers performed the chart review and validation was done on a small subset. Results  There were 966 eligible ED visits in the EMR sample and 731 in the claims sample. Agreement between reviewers was 95.45% and kappa statistic was 0.91. Mean age of the EMR sample was 22 years, and mostly white (93%). Multiple models conventionally used in studies were evaluated and the final model chosen included principal diagnosis, bronchodilator, and steroid use for both algorithms, chief complaints for EMR, and secondary diagnosis for claims. Area under the curve was 0.93 (95% confidence interval: 0.91–0.94) and 0.94 (0.93–0.96), respectively, for EMR and claims data, with positive predictive value of > 94%. The algorithms are visually presented using nomograms. Conclusion  We were able to develop two separate algorithms for EMR and claims to identify asthma exacerbation-related ED visit with excellent diagnostic ability and varying discrimination threshold for clinical and research purposes. Georg Thieme Verlag KG 2018-07 2018-07-18 /pmc/articles/PMC6051766/ /pubmed/30040112 http://dx.doi.org/10.1055/s-0038-1666994 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Sundaresan, Agnes S.
Schneider, Gargi
Reynolds, Joy
Kirchner, H. Lester
Identifying Asthma Exacerbation-Related Emergency Department Visit Using Electronic Medical Record and Claims Data
title Identifying Asthma Exacerbation-Related Emergency Department Visit Using Electronic Medical Record and Claims Data
title_full Identifying Asthma Exacerbation-Related Emergency Department Visit Using Electronic Medical Record and Claims Data
title_fullStr Identifying Asthma Exacerbation-Related Emergency Department Visit Using Electronic Medical Record and Claims Data
title_full_unstemmed Identifying Asthma Exacerbation-Related Emergency Department Visit Using Electronic Medical Record and Claims Data
title_short Identifying Asthma Exacerbation-Related Emergency Department Visit Using Electronic Medical Record and Claims Data
title_sort identifying asthma exacerbation-related emergency department visit using electronic medical record and claims data
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051766/
https://www.ncbi.nlm.nih.gov/pubmed/30040112
http://dx.doi.org/10.1055/s-0038-1666994
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