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. 2018 May;103(5):899-905.
doi: 10.1002/cpt.861. Epub 2017 Oct 10.

Identifying Patients With High Data Completeness to Improve Validity of Comparative Effectiveness Research in Electronic Health Records Data

Kueiyu Joshua Lin  1   2   3 , Daniel E Singer  2   3 , Robert J Glynn  1   3 , Shawn N Murphy  4 , Joyce Lii  1 , Sebastian Schneeweiss  1   3
Affiliations

Identifying Patients With High Data Completeness to Improve Validity of Comparative Effectiveness Research in Electronic Health Records Data

Kueiyu Joshua Lin et al. Clin Pharmacol Ther. 2018 May.

Abstract

Electronic health record (EHR)-discontinuity, i.e., having medical information recorded outside of the study EHR system, is associated with substantial information bias in EHR-based comparative effectiveness research (CER). We aimed to develop and validate a prediction model identifying patients with high EHR-continuity to reduce this bias. Based on 183,739 patients aged ≥65 in EHRs from two US provider networks linked with Medicare claims data from 2007-2014, we quantified EHR-continuity by mean proportion of encounters captured (MPEC) by the EHR system. We built a prediction model for MPEC using one EHR system as training and the other as the validation set. Patients with top 20% predicted EHR-continuity had 3.5-5.8-fold smaller misclassification of 40 CER-relevant variables, compared to the remaining study population. The comorbidity profiles did not differ substantially by predicted EHR-continuity. These findings suggest that restriction of CER to patients with high predicted EHR-continuity may confer a favorable validity to generalizability trade-off.

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Conflict of interest statement

Conflict of interest: none declared

Figures

Figure 1
Figure 1
Assessment of electronic health record continuity and proxy indicators
Figure 2
Figure 2
Mean difference in combined comorbidity score based on linked claims-EHR data vs. EHR alone
Figure 3
Figure 3
Decreasing misclassification of key variables associated with increasing predicted EHR-continuity
Figure 4
Figure 4
Representativeness: comparison of combined comorbidity score in those with predicted high vs. low EHR-continuity in EHR system 1
See this image and copyright information in PMC

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