Validating a case definition for adult asthma in primary care electronic medical records

Cave, Andrew; Soós, Boglárka; Gillies, Christina; Drummond, Neil; Pham, Anh Nguyet; Williamson, Tyler

doi:10.1038/s41533-020-0181-3

Cited by 8 publications

(15 citation statements)

References 12 publications

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“…In Canada, there have been recent attempts to create a case definition for asthma suitable for Canadian EMR vendors and primary care practitioners. Previous efforts to create and validate case definitions for asthma have come from a single EMR or restricted data environments [ 68 , 69 ]. Xi et al ( 68 ) proposed a variety of case definitions using similar search fields with the addition of a search for asthma in the free text portion of the EMR and found a case definition of asthma that had a sensitivity of 90.2%, and a specificity of 83.9% [ 68 ].…”

Section: Discussionmentioning

confidence: 99%

“…Xi et al ( 68 ) proposed a variety of case definitions using similar search fields with the addition of a search for asthma in the free text portion of the EMR and found a case definition of asthma that had a sensitivity of 90.2%, and a specificity of 83.9% [ 68 ]. Another recent publication from Cave et al ( 69 ) conducted a study to validate a case definition for asthma using data from the Southern Alberta Primary Care Research Network, a node of the CPCSSN (SAPCReN-CPCSSN) [ 69 ]. The authors created a case-finding algorithm using a combination of search fields from the EMR including billing information, recorded encounter diagnosis information, and information inputted into a health condition field within the EMR.…”

Section: Discussionmentioning

confidence: 99%

“…This can limit the scalability of the eTools to other settings. The majority of KT eTools that have been developed are only functional in one EMR environment or derive information from health administrative data, which is limited in detail [ 38 , 67 – 69 ]. While these tools may be effective in a local context, the inability to scale tools across multiple EMRs and the limited information provided by health administrative data create limitations on the ability of these KT eTools to scale to the national and international level.…”

Section: Discussionmentioning

confidence: 99%

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Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement

Moloney

Digby

MacKinnon

et al. 2023

Allergy Asthma Clin Immunol

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Background Viable knowledge translation (KT) strategies are increasingly sought to improve asthma diagnosis, particularly in primary care. Despite this understanding, practical KT tools to support primary care practitioners are not widely available. Electronic medical records (EMRs) offer an opportunity to optimize the diagnosis and surveillance of chronic diseases such as asthma, and support quality improvement initiatives that increase adherence to guideline-recommended care. This review aims to describe the current state of electronic KT electronic tools (eTools) and surveillance systems for asthma and identify opportunities to increase adherence to asthma diagnostic guidelines by implementing digital KT eTools. Methods Systematic literature searches were conducted on Ovid MEDLINE that included the search terms: asthma, asthma diagnosis, asthma surveillance, electronic health records, translational medical research, quality improvement, professional practice gaps, and primary health care published in the previous 10 years. In total, the searches returned 971 articles, 163 of which were considered relevant and read in full. An additional 28 articles were considered after reviewing the references from selected articles. 75 articles were included in this narrative review. Results Established KT eTools for asthma such as electronic questionnaires, computerized clinical decision support systems (CDSS), chronic disease surveillance networks, and asthma registries have been effective in improving the quality of asthma diagnosis and care. As well, chronic disease surveillance systems, severe asthma registries, and workplace asthma surveillance systems have demonstrated success in monitoring asthma outcomes. However, lack of use and/or documentation of objective measures of lung function, challenges in identifying asthma cases in EMRs, and limitations of data sources have created barriers in the development of KT eTools. Existing digital KT eTools that overcome these data quality limitations could provide an opportunity to improve adherence to best-practice guidelines for asthma diagnosis and management. Conclusion Future initiatives in the development of KT eTools for asthma care should focus on strategies that assist healthcare providers in accurately diagnosing and documenting cases of asthma. A digital asthma surveillance system could support adherence to best-practice guidelines of asthma diagnosis and surveillance by prompting use of objective methods of confirmation to confirm an asthma diagnosis within the EMR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement

Moloney

Digby

MacKinnon

et al. 2023

Allergy Asthma Clin Immunol

View full text Add to dashboard Cite

show abstract

“…The use of ICD codes has been validated for asthma, COPD, respiratory tract infection, as well as COVID-19. [13][14][15][16] The effect of the COVID-19 pandemic on viral testing results and health service use was estimated using an interrupted times series framework with level change only. 17 We analysed a level change only as we expected an immediate and drastic impact of the pandemic on viral testing results and health service use, but had no hypothesis of change in ongoing secular trends, the proper analysis of which will require years more follow-up data.…”

Section: Data Sourcesmentioning

confidence: 99%

Examining the effect of the COVID-19 pandemic on community virus prevalence and healthcare utilisation reveals that peaks in asthma, COPD and respiratory tract infection occur with the re-emergence of rhino/enterovirus

Ho¹,

Shahzad

Jones

et al. 2023

Thorax

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IntroductionAirway disease exacerbations are cyclical related to respiratory virus prevalence. The COVID-19 pandemic has been associated with reduced exacerbations possibly related to public health measures and their impact on non-COVID-19 respiratory viruses. We aimed to investigate the prevalence of non-COVID-19 respiratory viruses during the pandemic compared with prior in Ontario, Canada and healthcare utilisation related to asthma, chronic obstructive pulmonary disease (COPD) and respiratory tract infection.MethodsThis is a population-based retrospective analysis of respiratory virus tests, emergency department (ED) visits and hospitalisations between 2015 and 2021 in Ontario. Weekly virus testing data were used to estimate viral prevalence for all non-COVID-19 respiratory viruses. We plotted the %positivity and observed and expected counts of each virus to visualise the impact of the pandemic. We used Poisson and binomial logistic regression models to estimate the change in %positivity, count of positive viral cases and count of healthcare utilisation during the pandemic.ResultsThe prevalence of all non-COVID-19 respiratory viruses decreased dramatically during the pandemic compared with prior. Comparing periods, the incidence rate ratio (IRR) for positive cases corresponded to a >90% reduction for non-COVID-19 respiratory viruses except adenovirus and rhino/enterovirus. Asthma-related ED visits and hospital admissions fell by 57% (IRR 0.43 (95% CI 0.37 to 0.48)) and 61% (IRR 0.39 (95% CI 0.33 to 0.46)). COPD-related ED visits and admissions fell by 63% (IRR 0.37 (95% CI 0.30 to 0.45)) and 45% (IRR 0.55 (95% CI 0.48 to 0.62)). Respiratory tract infection ED visits and admissions fell by 85% (IRR 0.15 (95% CI 0.10 to 0.22)), and 85% (IRR 0.15 (95% CI 0.09 to 0.24)). Rather than the usual peaks in disease condition, during the pandemic, healthcare utilisation peaked in October when rhino/enterovirus peaked.ConclusionsThe prevalence of nearly all non-COVID-19 respiratory viruses decreased during the pandemic and was associated with marked reductions in ED visits and hospitalisations. The re-emergence of rhino/enterovirus was associated with increased healthcare utilisation.

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“…CPCSSN has validated case definitions for 13 chronic conditions, including COPD [10]. There have also been efforts to create case definitions for adult asthma using EMR data directly by Xi et al [11], and using EMR data extracted into the CPCSSN database by Cave et al [12]. To date, there remains no standardized case definition for diagnosis of asthma in primary care that can be applied to EMRs and databases across Canada.…”

Section: Introductionmentioning

confidence: 99%

Validation of adult asthma case definitions for primary care sentinel surveillance

Moloney,

Morra,

Morkem

et al. 2023

Allergy Asthma Clin Immunol

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Background Most asthma diagnoses and patient care take place in primary care settings. Electronic medical records (EMRs) offer an opportunity to utilize technology to improve asthma diagnosis and care. The purpose of this study was to create and validate separate case definitions for suspected and confirmed asthma in primary care EMRs, to enable surveillance, benchmarking, and quality improvement in primary care settings. The objective of this study was to develop a case definition for suspected and confirmed asthma for use in a primary care sentinel surveillance system. Methods A single chart abstractor conducted a manual audit of 776 randomly selected patient charts from an academic primary care practice EMR in Kingston, Ontario. Following the single chart abstractor classification, a consensus on chart classification as “not asthma”, “suspected asthma”, or “confirmed asthma” was achieved between the abstractor, a family physician, and a respirologist using Canadian Thoracic Society (CTS) criteria. Case definition algorithms based on billing codes, clinical data elements and medications were applied to the site’s Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data for the same charts and compared to abstractor classifications to determine each algorithm’s measurement properties. Results The prevalence of suspected and confirmed asthma were 7.3% (n = 54) and 2.4% (n = 18), respectively. None of the proposed case definitions could differentiate between suspected and confirmed asthma. One algorithm consisting of billing, clinical, and medication elements had the highest Youden’s Index for either suspected or confirmed asthma. The algorithm had a sensitivity of 81%, a specificity of 96%, positive predictive value of 71%, negative predictive value of 98%, and a Youden’s Index of 0.77 for combined suspected or confirmed asthma cases. Conclusion An EMR case definition for suspected or confirmed adult asthma has been validated for use in CPCSSN. Implementation of this case definition will enable the development of a surveillance electronic tool (eTool) for adult asthma that can foster quality improvement.

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Validating a case definition for adult asthma in primary care electronic medical records

Cited by 8 publications

References 12 publications

Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement

Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement

Examining the effect of the COVID-19 pandemic on community virus prevalence and healthcare utilisation reveals that peaks in asthma, COPD and respiratory tract infection occur with the re-emergence of rhino/enterovirus

Validation of adult asthma case definitions for primary care sentinel surveillance

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