scholarly journals Assessing the concordance and accuracy between hospital discharge data, electronic health records, and register books for diagnosis of inpatient admissions of miscarriage: A retrospective linked data study

2021 ◽  
Author(s):  
Indra San Lazaro Campillo ◽  
Sarah Meaney ◽  
Maria Harrington ◽  
Karen McNamara ◽  
Anna Maria Verling ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Hospital Discharge ◽  
Linked Data ◽  
Hospital Discharge Data ◽  
Health Records ◽  
Discharge Data ◽  
Electronic Health

scholarly journals Hospital discharge data is not accurate enough to monitor the incidence of postpartum hemorrhage

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246119
Author(s):  
Diana Walther ◽  
Patricia Halfon ◽  
Romain Tanzer ◽  
Bernard Burnand ◽  
Moira Robertson ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Hospital Discharge ◽  
Postpartum Hemorrhage ◽  
Cumulative Incidence ◽  
Hospital Discharge Data ◽  
Detection Accuracy ◽  
Health Records ◽  
Discharge Data ◽  
Maternity Hospitals ◽  
Electronic Health

Introduction Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality worldwide. Therefore, cumulative incidence of postpartum hemorrhage and severe postpartum hemorrhage are commonly monitored within and compared across maternity hospitals or countries for obstetrical safety improvement. These indicators are usually based on hospital discharge data though their accuracy is seldom assessed. We aimed to measure postpartum hemorrhage and severe postpartum hemorrhage using electronic health records and hospital discharge data separately and compare the detection accuracy of these methods to manual chart review, and to examine the temporal trends in cumulative incidence of these potentially avoidable adverse outcomes. Materials and methods We analyzed routinely collected data of 7904 singleton deliveries from a large Swiss university hospital for a three year period (2014–2016). We identified postpartum hemorrhage and severe postpartum hemorrhage in electronic health records by text mining discharge letters and operative reports and calculating drop in hemoglobin from laboratory tests. Diagnostic and procedure codes were used to identify cases in hospital discharge data. A sample of 334 charts was reviewed manually to provide a reference-standard and evaluate the accuracy of the other detection methods. Results Sensitivities of detection algorithms based on electronic health records and hospital discharge data were 95.2% (95% CI: 92.6% 97.8%) and 38.2% (33.3% to 43.0%), respectively for postpartum hemorrhage, and 87.5% (85.2% to 89.8%) and 36.2% (26.3% to 46.1%) for severe postpartum hemorrhage. Postpartum hemorrhage cumulative incidence based on electronic health records decreased from 15.6% (13.1% to 18.2%) to 8.5% (6.7% to 10.5%) from the beginning of 2014 to the end of 2016, with an average of 12.5% (11.8% to 13.3%). The cumulative incidence of severe postpartum hemorrhage remained at approximately 4% (3.5% to 4.4%). Hospital discharge data-based algorithms provided significantly underestimated incidences. Conclusions Hospital discharge data is not accurate enough to assess the incidence of postpartum hemorrhage at hospital or national level. Instead, automated algorithms based on structured and textual data from electronic health records should be considered, as they provide accurate and timely estimates for monitoring and improvement in obstetrical safety. Furthermore, they have the potential to better code for postpartum hemorrhage thus improving hospital reimbursement.

scholarly journals Postpartum Hemorrhage: Differences in Definition, Data and Incidence

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Diana Walther ◽  
Patricia Halfon ◽  
David Desseauve ◽  
Yvan Vial ◽  
Bernard Burnand ◽  
...  
Keyword(s):  
Blood Loss ◽  
Electronic Health Records ◽  
Data Quality ◽  
Data Availability ◽  
University Hospital ◽  
Diagnostic Code ◽  
Health Records ◽  
Discharge Data ◽  
Diagnostic Codes ◽  
Electronic Health

IntroductionPostpartum hemorrhage (PPH) remains a major cause of morbidity and mortality worldwide. Geo-temporal comparisons of in-hospital PPH incidence remain a challenge due to differences in definition, data quality and the absence of accurate, validated indicators. Objectives and ApproachTo compare the incidence of PPH using different definitions to assess the need for a validated indicator. Singleton births from 2014-2016 at Lausanne University Hospital, Switzerland, were included. PPH was defined based on 1) clinical diagnosis using International Classification of Diseases (ICD-10-GM) PPH diagnostic codes, 2) volume of blood loss ≥500ml for vaginal births and ≥1000ml for cesareans 3) peripartum Hb change >2g/dl in vaginal births and ≥4g/dl in cesareans and 4) fulfillment of criteria from definition one, two or three. Data were extracted from hospital discharge data and linked with electronic health records. ResultsThere were 2529, 2660 and 2715 singleton births in 2014, 2015 and 2016, respectively, 28.8% were cesareans. Peripartum change in Hb was available for 17% of births. The incidence (95% CI) of PPH in 2014, 2015 and 2016 was, respectively: 1)6.0% (5.1, 7.0), 6.3% (5.4, 7.3) and 7.9% (6.9, 9.0) based on diagnostic codes; 2)7.9% (6.8, 9.0), 7.1% (6.2, 8.2) and 7.2% (6.3, 8.3) based on blood loss volumes; 3)2.4% (1.8, 3.1), 2.7% (2.1, 3.4) and 3.5% (2.9, 4.3) based on change in Hb; 4)11.3% (10.1, 12.6), 10.4% (9.3, 11.6) and 11.0% (9.9, 12.3) based on the combined definition. Differences in PPH incidence by year between definitions one and four, two and four and three and four were all statistically significant (McNemar p-values Conclusion/ImplicationsIncidence varied widely according to definition and data availability, not to mention data quality. Our results highlight the need for a validated PPH indicator to enable monitoring. Future prospects include the validation of a diagnostic code based PPH indicator aided by text mining in electronic health records.

scholarly journals Concordance and timing in recording cancer events in primary care, hospital and mortality records for patients with and without psoriasis: A population-based cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254661
Author(s):  
Alex M. Trafford ◽  
Rosa Parisi ◽  
Martin K. Rutter ◽  
Evangelos Kontopantelis ◽  
Christopher E. M. Griffiths ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Records ◽  
Linked Data ◽  
Mortality Data ◽  
Clinical Practice Research Datalink ◽  
Care Hospital ◽  
Health Records ◽  
Primary Care Hospital ◽  
Electronic Health ◽  
Risk Of Cancer

Background The association between psoriasis and the risk of cancer has been investigated in numerous studies utilising electronic health records (EHRs), with conflicting results in the extent of the association. Objectives To assess concordance and timing of cancer recording between primary care, hospital and death registration data for people with and without psoriasis. Methods Cohort studies delineated using primary care EHRs from the Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases, with linkage to hospital episode statistics (HES), Office for National Statistics (ONS) mortality data and indices of multiple deprivation (IMD). People with psoriasis were matched to those without psoriasis by age, sex and general practice. Cancer recording between databases was investigated by proportion concordant, that being the presence of cancer record in both source and comparator datasets. Delay in recording cancer diagnoses between CPRD and HES records and predictors of discordance were also assessed. Results 58,904 people with psoriasis and 350,592 comparison patients were included using CPRD GOLD; whereas 213,400 people with psoriasis and 1,268,998 comparison patients were included in CPRD Aurum. For all cancer records (excluding keratinocyte), concordance between CPRD and HES was greater than 80%. Concordance for same-site cancer records was markedly lower (<68% GOLD-linked data; <72% Aurum-linked data). Concordance of non-Hodgkin lymphoma and liver cancer recording between CPRD and HES was lower for people with psoriasis compared to those without. Conclusions Concordance between CPRD and HES is poor when restricted to cancers of the same site, with greater discordance in people with psoriasis for some cancers of specific sites. The use of linked patient-level data is an important step in reducing misclassification of cancer outcomes in epidemiological studies using routinely collected electronic health records.

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