Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Nov 4;2(1):14.
doi: 10.13063/2327-9214.1109.

Estimating screening test utilization using electronic health records data

Ra Hubbard  1 , J Chubak  1 , Cm Rutter  1
Affiliations

Estimating screening test utilization using electronic health records data

Ra Hubbard et al. EGEMS (Wash DC). .

Abstract

Background: Electronic health records (EHRs) are increasingly used by medical providers and offer a wide-reaching source of information on utilization of preventive services. Numerous measures used for quality assessment and public reporting are estimated based on EHR data. However, sources of error and misclassification can lead to over- or under-estimation of true utilization rates. EHR-derived measures of screening test use are subject to error due to misclassification of screening and diagnostic tests. The implications of this misclassification for EHR-based screening utilization estimates have not been well explored.

Objectives: We calculated the bias in estimates of screening test utilization associated with several published EHR-based algorithms for identifying screening colonoscopies and propose two simple methods to correct this bias. We apply these corrections to obtain adjusted estimates of screening colonoscopy utilization using EHR data from Group Health, an integrated healthcare system in Washington-state.

Findings: The bias in screening colonoscopy utilization estimates ranged from an under-estimate of 3 to an over-estimate of 12 percentage points across classification methods. If the operating characteristics of the classification method are known or if a statistical model that returns predicted probabilities of screening indication is applied in the population of interest, this information can be used to obtain unbiased estimates through simple corrections to the utilization rates with little loss of precision. When applied to data on colonoscopies received at Group Health, we found that an unadjusted estimate was 4 percentage points higher than our adjusted estimate.

Discussion: Error in classification of tests as screening when using EHR data to study screening utilization should be accounted for in order to eliminate bias and prevent spurious findings.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Estimated Proportion of Individuals with Screening Test Utilization for 10,000 Simulated Populations Note: The dotted line indicates true screening utilization rate.
See this image and copyright information in PMC

References

    1. National Committee on Quality Assurance. HEDIS 2014 Volume 2: Technical Specifications for Health Plans. Washington, DC: National Committee on Quality Assurance; 2014.
    1. Centers for Medicare & Medicaid Services. Hospital Out-patient Quality Reporting (OQR) Program Overview. 2014. [August 25, 2014]; Available from: http://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2....
    1. Cronin KA, Miglioretti DL, Krapcho M, Yu B, Geller BM, Carney PA, et al. Bias associated with self-report of prior screening mammography. Cancer Epidemiol Biomarkers Prev. 2009;18(6):1699–705. Epub 2009/06/10. - PMC - PubMed
    1. Rauscher GH, Johnson TP, Cho YI, Walk JA. Accuracy of self-reported cancer-screening histories: a meta-analysis. Cancer Epidemiol Biomarkers Prev. 2008;17(4):748–57. Epub 2008/04/03. - PubMed
    1. National Quality Forum. Quality Positioning System. [August 25, 2014]; Available from: http://www.qualityforum.org/qps/.

LinkOut - more resources