Rationale, design and respondent characteristics of the 2013–2014 New York City Health and Nutrition Examination Survey (NYC HANES 2013–2014)

Thorpe, Lorna E.; Greene, Carolyn M.; Freeman, Amy; Snell, Elisabeth F.; Rodriguez-Lopez, Jesica S.; Frankel, Martin R.; Punsalang, Amado; Chernov, Claudia; Lurie, Elizabeth; Friedman, Mark J.; Koppaka, Ram; Perlman, Sharon E.

doi:10.1016/j.pmedr.2015.06.019

Cited by 53 publications

(59 citation statements)

References 15 publications

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“…The 2013–2014 NYC HANES is a representative population-based survey of adults ages 20 years and older, based on household-based sampling, in-person interviews, a brief physical examination, and collection of fasting biological specimens 26. The final sample consisted of 1,524 NYC adults, 1,135 of whom reported having visited a provider for primary care in the past year (“in care”) and who had a valid NYC ZIP code.…”

Section: Methodsmentioning

confidence: 99%

Monitoring Prevalence, Treatment, and Control Of Metabolic Conditions In New York City Adults Using 2013 Primary Care Electronic Health Records: A Surveillance Validation Study

Thorpe¹,

McVeigh²,

Perlman³

et al. 2016

eGEMs

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Introduction:Electronic health records (EHRs) can potentially extend chronic disease surveillance, but few EHR-based initiatives tracking population-based metrics have been validated for accuracy. We designed a new EHR-based population health surveillance system for New York City (NYC) known as NYC Macroscope. This report is the third in a 3-part series describing the development and validation of that system. The first report describes governance and technical infrastructure underlying the NYC Macroscope. The second report describes validation methods and presents validation results for estimates of obesity, smoking, depression and influenza vaccination. In this third paper we present validation findings for metabolic indicators (hypertension, hyperlipidemia, diabetes).Methods:We compared EHR-based estimates to those from a gold standard surveillance source - the 2013–2014 NYC Health and Nutrition Examination Survey (NYC HANES) - overall and stratified by sex and age group, using the two one-sided test of equivalence and other validation criteria.Results:EHR-based hypertension prevalence estimates were highly concordant with NYC HANES estimates. Diabetes prevalence estimates were highly concordant when measuring diagnosed diabetes but less so when incorporating laboratory results. Hypercholesterolemia prevalence estimates were less concordant overall. Measures to assess treatment and control of the 3 metabolic conditions performed poorly.Discussion:While indicator performance was variable, findings here confirm that a carefully constructed EHR-based surveillance system can generate prevalence estimates comparable to those from gold-standard examination surveys for certain metabolic conditions such as hypertension and diabetes.Conclusions:Standardized EHR metrics have potential utility for surveillance at lower annual costs than surveys, especially as representativeness of contributing clinical practices to EHR-based surveillance systems increases.

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Section: Methodsmentioning

confidence: 99%

Monitoring Prevalence, Treatment, and Control Of Metabolic Conditions In New York City Adults Using 2013 Primary Care Electronic Health Records: A Surveillance Validation Study

Thorpe¹,

McVeigh²,

Perlman³

et al. 2016

eGEMs

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“…1,3,[11][12][13][14][15] The degree of adherence in the real world to these measurement guidelines, whether in the physician's office or at home, has not been adequately studied. The purpose of this study was to evaluate adherence to the published recommendations for BP measurement obtained both in the clinic and at home, focusing specifically on the number of measurements taken and waiting time prior to obtaining the measurements.…”

mentioning

confidence: 99%

Nonadherence to Recommended Guidelines for Blood Pressure Measurement

Levy

Gerber

et al. 2016

J of Clinical Hypertension

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Accuracy of blood pressure readings, both in the physician's office and at home, is crucial in properly managing hypertension. Few studies have investigated adherence to measurement guidelines. This study focused on two important aspects of blood pressure measurement: waiting time before measurement and number of readings taken. A total of 103 patients completed self‐report questionnaires about office and home blood pressure measurements, with 77% reporting that physician measurements were obtained without waiting, and 56% reporting that only one reading was obtained. The proportions were even higher when measured by a nurse/technician, 96% and 81%, respectively. Home readings were taken without waiting by 60%, and 40% reported taking only a single reading. Most patients received no measurement instructions. Nonadherence to measurement guidelines is common, and may be affecting the validity of readings obtained both in physicians' offices and at home, with significant and potentially harmful effects on treatment decisions.

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“…NYC HANES is a representative population-based survey that uses household-based sampling for in-person interviews, a brief physical examination, collection of specimens, and computerized self-interview. Full NYC HANES methodology is described by Thorpe et al9 The final sample consisted of 1,524 NYC adults 20 years of age and older, of whom 1,135 reported having seen a provider for primary care services in the past year. Estimates were limited to this in-care population.…”

Section: Methodsmentioning

confidence: 99%

Design of the New York City Macroscope: Innovations in Population Health Surveillance Using Electronic Health Records

Newton-Dame¹,

McVeigh²,

Schreibstein³

et al. 2016

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Introduction:Electronic health records (EHRs) have the potential to offer real-time, inexpensive standardized health data about chronic health conditions. Despite rapid expansion, EHR data evaluations for chronic disease surveillance have been limited. We present design and methods for the New York City (NYC) Macroscope, an EHR-based chronic disease surveillance system.This methods report is the first in a three part series describing the development and validation of the NYC Macroscope. This report describes in detail the infrastructure underlying the NYC Macroscope; indicator definitions; design decisions that were made to maximize data quality; characteristics of the population sampled; completeness of data collected; and lessons learned from doing this work. The second report describes the methods used to evaluate the validity and robustness of NYC Macroscope prevalence estimates; presents validation results for estimates of obesity, smoking, depression and influenza vaccination; and discusses the implications of our findings for NYC and for other jurisdictions embarking on similar work. The third report applies the same validation methods to metabolic outcomes, including the prevalence, treatment and control of diabetes, hypertension and hyperlipidemia.Methods:We designed the NYC Macroscope for comparison to a local “gold standard,” the 2013–14 NYC Health and Nutrition Examination Survey, and the telephonic 2013 Community Health Survey. NYC Macroscope indicators covered prevalence, treatment, and control of diabetes, hypertension, and hyperlipidemia; and prevalence of influenza vaccination, obesity, depression and smoking. Indicators were stratified by age, sex, and neighborhood poverty, and weighted to the in-care NYC population and limited to primary care patients. Indicator queries were distributed to a virtual network of primary care practices; 392 practices and 716,076 adult patients were retained in the final sample.Findings:The NYC Macroscope covered 10% of primary care providers and 15% of all adult patients in NYC in 2013 (8–47% of patients by neighborhood). Data completeness varied by domain from 98% for blood pressure among patients with hypertension to 33% for depression screening.Discussion:Design and validation efforts undertaken by NYC are described here to provide one potential blueprint for leveraging EHRs for population health monitoring. To replicate a model like NYC Macroscope, jurisdictions should establish buy-in; build informatics capacity; use standard, simple case defnitions; establish documentation quality thresholds; restrict to primary care providers; and weight the sample to a target population.

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Rationale, design and respondent characteristics of the 2013–2014 New York City Health and Nutrition Examination Survey (NYC HANES 2013–2014)

Cited by 53 publications

References 15 publications

Monitoring Prevalence, Treatment, and Control Of Metabolic Conditions In New York City Adults Using 2013 Primary Care Electronic Health Records: A Surveillance Validation Study

Monitoring Prevalence, Treatment, and Control Of Metabolic Conditions In New York City Adults Using 2013 Primary Care Electronic Health Records: A Surveillance Validation Study

Nonadherence to Recommended Guidelines for Blood Pressure Measurement

Design of the New York City Macroscope: Innovations in Population Health Surveillance Using Electronic Health Records

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