Recording of hospitalizations for acute exacerbations of COPD in UK electronic health care records

Abstract

BackgroundAccurate identification of hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) within electronic health care records is important for research, public health, and to inform health care utilization and service provision. We aimed to develop a strategy to identify hospitalizations for AECOPD in secondary care data and to investigate the validity of strategies to identify hospitalizations for AECOPD in primary care data.MethodsWe identified patients with chronic obstructive pulmonary disease (COPD) in the Clinical Practice Research Datalink (CPRD) with linked Hospital Episodes Statistics (HES) data. We used discharge summaries for recent hospitalizations for AECOPD to develop a strategy to identify the recording of hospitalizations for AECOPD in HES. We then used the HES strategy as a reference standard to investigate the positive predictive value (PPV) and sensitivity of strategies for identifying AECOPD using general practice CPRD data. We tested two strategies: 1) codes for hospitalization for AECOPD and 2) a code for AECOPD other than hospitalization on the same day as a code for hospitalization due to unspecified reason.ResultsIn total, 27,182 patients with COPD were included. Our strategy to identify hospitalizations for AECOPD in HES had a sensitivity of 87.5%. When compared with HES, using a code suggesting hospitalization for AECOPD in CPRD resulted in a PPV of 50.2% (95% confidence interval [CI] 48.5%–51.8%) and a sensitivity of 4.1% (95% CI 3.9%–4.3%). Using a code for AECOPD and a code for hospitalization due to unspecified reason resulted in a PPV of 43.3% (95% CI 42.3%–44.2%) and a sensitivity of 5.4% (95% CI 5.1%–5.7%).ConclusionHospitalization for AECOPD can be identified with high sensitivity in the HES database. The PPV and sensitivity of strategies to identify hospitalizations for AECOPD in primary care data alone are very poor. Primary care data alone should not be used to identify hospitalizations for AECOPD. Instead, researchers should use data that are linked to data from secondary care.

Effects of Pulmonary Rehabilitation on Exacerbation Number and Severity in People With COPD

“…We used a previously validated definition to identify AECOPD in CPRD and HES. 16,17 IRB approval was not required as this study used anonymous patient data. Approval was obtained from the CPRD Independent Scientific Advisory Committee (ISAC), prior to study start which oversees research involving CPRD data (protocol ref: 15_193R; available on request).…”

Chronic obstructive pulmonary disease exacerbation episodes derived from electronic health record data validated using clinical trial data

“…For all patients within SLS COPD, we used existing algorithms to identify moderate/severe AECOPD . The algorithms identify AECOPD episodes using a two‐stage procedure.…”

“…We assessed moderate/severe AECOPD episodes using the existing algorithms in the Salford Integrated Record EHR for trial patients in both the usual care and initiation of treatment with fluticasone furoate/vilanterol arms, comparing them with episodes reported in the eCRF for the same patients within the same time period. We compared descriptive characteristics regarding the episodes according to the two definitions including total and mean numbers of episodes and total and mean episode lengths.…”

“…For all patients within SLS COPD, we used existing algorithms to identify moderate/severe AECOPD. 6,7 The algorithms identify AECOPD episodes using a two-stage procedure. First, an AECOPD episode on a given day was defined as any of the following events, using relevant • Antibiotic and oral corticosteroid prescriptions on the same day, each for a period of 5 to 14 days,…”

“…Recently, Rothnie and colleagues developed a well-discriminating algorithm to identify AECOPD episodes in EHR data in a UK setting and validated this using questionnaire data from general practitioners (GPs) or hospital discharge summaries, reviewed by respiratory physicians. 6,7 However, there are limitations to consider: it is not clear what the gold standard should be (ie, the start and end date of AECOPD episodes may not always be recorded by a health care professional); there is potential response bias, 8 and predictive values observed in one study may not apply to all populations, in terms of generalizability across health care settings, systems, or geographies. 9 In this short paper, we validate a method of ascertaining moderate/severe AECOPD episodes from EHR data, developed using the Salford Integrated Record EHR system, against AECOPD episode data collected through an electronic case report form…”