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. 2021 Dec 18;5(1):132.
doi: 10.1186/s41687-021-00401-2.

Combining patient reported outcomes and EHR data to understand population level treatment needs: correcting for selection bias in the migraine signature study

Walter F Stewart  1 , Xiaowei Yan  2 , Alice Pressman  3 , Alice Jacobson  2 , Shruti Vaidya  2 , Victoria Chia  4 , Dawn C Buse  5 , Richard B Lipton  5   6
Affiliations

Combining patient reported outcomes and EHR data to understand population level treatment needs: correcting for selection bias in the migraine signature study

Walter F Stewart et al. J Patient Rep Outcomes. .

Abstract

Background: Electronic health records (EHR) data can be used to understand population level quality of care especially when supplemented with patient reported data. However, survey non-response can result in biased population estimates. As a case study, we demonstrate that EHR and survey data can be combined to estimate primary care population prescription treatment status for migraine stratified by migraine disability, without and with adjustment for survey non-response bias. We selected disability as it is associated with survey participation and patterns of prescribing for migraine.

Methods: A stratified random sample of Sutter Health adult primary care (PC) patients completed a digital survey about headache, migraine, and migraine related disability. The survey data from respondents with migraine were combined with their EHR data to estimate the proportion who had prescription orders for acute or preventive migraine treatments. Separate proportions were also estimated for those with mild disability (denoted "mild migraine") versus moderate to severe disability (denoted mod-severe migraine) without and with correction, using the inverse propensity weighting method, for non-response bias. We hypothesized that correction for non-response bias would result in smaller differences in proportions who had a treatment order by migraine disability status.

Results: The response rate among 28,268 patients was 8.2%. Among survey respondents, 37.2% had an acute treatment order and 16.8% had a preventive treatment order. The response bias corrected proportions were 26.2% and 11.6%, respectively, and these estimates did not differ from the total source population estimates (i.e., 26.4% for acute treatments, 12.0% for preventive treatments), validating the correction method. Acute treatment orders proportions were 32.3% for mild migraine versus 37.3% for mod-severe migraine and preventive treatment order proportions were 12.0% for mild migraine and 17.7% for mod-severe migraine. The response bias corrected proportions for acute treatments were 24.8% for mild migraine and 26.6% for mod-severe migraine and the proportions for preventive treatment were 8.1% for mild migraine and 12.0% for mod-severe migraine.

Conclusions: In this study, we combined survey data with EHR data to better understand treatment needs among patients diagnosed with migraine. Migraine-related disability is directly related to preventive treatment orders but less so for acute treatments. Estimates of treatment status by self-reported disability status were substantially over-estimated among those with moderate to severe migraine-related disability without correction for non-response bias.

Keywords: Electronic health records; Migraine disability; Non-response bias; Prescription medications.

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Conflict of interest statement

The Migraine Signature Study was funded by a research grant to Sutter Health and the Albert Einstein College of Medicine from Amgen. Walter F. Stewart has served as a consultant to Promius/Dr. Reddy and Allergan. Dawn C. Buse has served as a consultant to Amgen/Novartis, Allergan, Biohaven, Eli Lilly, Promius/Dr. Reddy’s, and Teva Pharmaceuticals. She is on the editorial board of Current Pain and Headache Reports. Richard B. Lipton serves on the editorial board of Neurology, as senior advisor to Headache, and as associate editor of Cephalalgia; he holds stock options in Biohaven Holdings and CtrlM Health. He receives research support from the NIH and FDA. He serves as consultant, advisory board member, has received honoraria from or research support from: Abbvie (Allergan), Amgen, Biohaven, Dr. Reddy’s (Promius), Electrocore, Eli Lilly, eNeura, Equinox, GlaxoSmithKline, Grifols, Lundbeck (Alder), Merck, Pernix, and Teva. He receives royalties from Wolff’s Headache 7th and 8th Edition, Oxford University Press, 2009, Wiley and Informa. Xiaowei Yan has no conflict of interest to claim. Alice Pressman has no conflict of interest to claim. Alice Jacobson has no conflict of interest to claim. Shruti Vaidya has no conflict of interest to claim. Victoria Chia is an employee of, and shareholder in, Amgen Inc.

Figures

Fig. 1
Fig. 1
Flowchart of population selection and sampling based on EHR data. MPA5Y > 10 Patient is likely to have had migraine at some point in the past 5 years. **MPA2Y > 10 Patient is likely to have used care for migraine in the past 2 years. ***Headache Care NOS5Y: Care for Headache Not Otherwise Specified during the study period
See this image and copyright information in PMC

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