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. 2018 Apr 13;6(1):4.
doi: 10.5334/egems.198.

A Framework for Leveraging "Big Data" to Advance Epidemiology and Improve Quality: Design of the VA Colonoscopy Collaborative

Samir Gupta  1 , Lin Liu  2 , Olga V Patterson  3 , Ashley Earles  1 , Ranier Bustamante  1 , Andrew J Gawron  3 , William K Thompson  4 , William Scuba  5 , Daniel Denhalter  1 , M Elena Martinez  2 , Karen Messer  2 , Deborah A Fisher  6 , Sameer D Saini  7 , Scott L DuVall  3 , Wendy W Chapman  3 , Mary A Whooley  8 , Tonya Kaltenbach  8
Affiliations

A Framework for Leveraging "Big Data" to Advance Epidemiology and Improve Quality: Design of the VA Colonoscopy Collaborative

Samir Gupta et al. EGEMS (Wash DC). .

Abstract

Objective: To describe a framework for leveraging big data for research and quality improvement purposes and demonstrate implementation of the framework for design of the Department of Veterans Affairs (VA) Colonoscopy Collaborative.

Methods: We propose that research utilizing large-scale electronic health records (EHRs) can be approached in a 4 step framework: 1) Identify data sources required to answer research question; 2) Determine whether variables are available as structured or free-text data; 3) Utilize a rigorous approach to refine variables and assess data quality; 4) Create the analytic dataset and perform analyses. We describe implementation of the framework as part of the VA Colonoscopy Collaborative, which aims to leverage big data to 1) prospectively measure and report colonoscopy quality and 2) develop and validate a risk prediction model for colorectal cancer (CRC) and high-risk polyps.

Results: Examples of implementation of the 4 step framework are provided. To date, we have identified 2,337,171 Veterans who have undergone colonoscopy between 1999 and 2014. Median age was 62 years, and 4.6 percent (n = 106,860) were female. We estimated that 2.6 percent (n = 60,517) had CRC diagnosed at baseline. An additional 1 percent (n = 24,483) had a new ICD-9 code-based diagnosis of CRC on follow up.

Conclusion: We hope our framework may contribute to the dialogue on best practices to ensure high quality epidemiologic and quality improvement work. As a result of implementation of the framework, the VA Colonoscopy Collaborative holds great promise for 1) quantifying and providing novel understandings of colonoscopy outcomes, and 2) building a robust approach for nationwide VA colonoscopy quality reporting.

Keywords: big data; electronic health records; epidemiology; quality improvement; veterans.

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Figures

Figure 1
Figure 1
Framework for leveraging “big data” for research and quality improvement purposes. Examples of implementation for each step proposed for the VA Colonoscopy Collaborative are provided. VA, Department of Veterans Affairs; NDI, National Death Index.
Figure 2
Figure 2
Risk Factors for CRC and High-Risk Polyps after Baseline Adenoma Removal. The VA Merit Review-supported cohort study will consider the potential influence of established and suspected risk factors for CRC and high-risk polyps. CRC, colorectal cancer.
Figure 3
Figure 3
Data Sources Available within VINCI. Data sources potentially accessible through VINCI include data created and maintained as usual healthcare, as well as external data sources that can be uploaded to VINCI. VA, Department of Veterans Affairs, VINCI, VA Informatics and Computing Infrastructure.
Figure 4
Figure 4
Workflow for NLP Algorithm Development and Validation.
See this image and copyright information in PMC

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