Selection of Medical Diagnostic Codes for Analysis of Electronic Patient Records. Application to Stroke in a Primary Care Database 英文参考文献.docVIP

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Selection of Medical Diagnostic Codes for Analysis of Electronic Patient Records. Application to Stroke in a Primary Care Database 英文参考文献.doc

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Selection of Medical Diagnostic Codes for Analysis of Electronic Patient Records. Application to Stroke in a Primary Care Database 英文参考文献

SelectionofMedicalDiagnosticCodesforAnalysisof ElectronicPatientRecords.ApplicationtoStrokeina PrimaryCareDatabase MartinC.Gulliford*,JudithCharlton,MarkAshworth,AnthonyG.Rudd,AndreMichaelToschke,forthe eCRTResearchTeam DivisionofHealthandSocialCareResearch,King’sCollegeLondon,London,UnitedKingdom Abstract Background: Electronic patient records from primary care databases are increasingly used in public health and health servicesresearchbutmethodsusedtoidentifycaseswithdiseasearenotwelldescribed.Thisstudyaimedtoevaluatethe relevanceofdifferentcodesfortheidentificationofacutestrokeinaprimarycaredatabase,andtoevaluatetrendsinthe useofdifferentcodesovertime. Methods:DatawereobtainedfromtheGeneralPracticeResearchDatabasefrom1997to2006.Allsubjectshadaminimum of24monthsofup-to-standardrecordbeforethefirstrecordedstrokediagnosis.Initially,weidentifiedstrokecasesusinga supplementedversionofthesetofcodesforprevalentstrokeusedbytheOfficeforNationalStatisticsinKeyhealthstatistics fromgeneralpractice1998(ONScodes).TheONScodeswerethenindependentlyreviewedbyfourratersandarestrictedset of121codesfor‘acutestroke’wasidentifiedbutthekappastatisticwaslowat0.23. Results:InitialextractionofdatausingtheONScodesgave48,239casesofstrokefrom1997to2006.Applicationofthe restrictedsetofcodesreducedthisto39,424cases.Therewere2,288caseswhoseindexmedicalcodeswerefor‘stroke annual review’ and 3,112 for ‘stroke monitoring’. The frequency of stroke review and monitoring codes as index codes increasedfrom9peryearin1997to1,612in2004,1,530in2005and1,424in2006.Theoneyearmortalityofcaseswiththe restrictedsetofcodeswas29.1%butfor‘strokeannualreview,’4.6%andfor‘strokemonitoringcodes’,5.7%. Conclusion:Intheanalysisofelectronicpatientrecords,differentmedicalcodesforasingleconditionmayhavevarying clinicalandprognosticsignificance;utilisationofdifferentmedicalcodesmaychangeovertime;researcherswithdiffering clinicalorepidemiologicalexperiencemayhavedifferinginterpretationsoftherelevanceofparticularcodes.Therei