What evidence is there for a delay in diagnostic coding of rheumatoid arthritis in UK general practice records? An observational study of free text

Ford, Elizabeth, Carroll, John, Smith, Helen, Davies, Kevin, Koeling, Rob, Petersen, Irene, Rait, Greta and Cassell, Jackie (2016) What evidence is there for a delay in diagnostic coding of rheumatoid arthritis in UK general practice records? An observational study of free text. BMJ Open, 6 (6). e010393. ISSN 2044-6055

[img] PDF - Accepted Version
Available under License Creative Commons Attribution.

Download (444kB)
[img] PDF - Published Version
Available under License Creative Commons Attribution.

Download (907kB)

Abstract

Objectives: Much research with electronic health records uses coded or structured data only; important information captured in the free text remains unused. One dimension of EHR data quality assessment is “currency” or timeliness, i.e. that data are representative of the patient state at the time of measurement. We explored the utility of free text in UK general practice patient records to evaluate delays in recording of rheumatoid arthritis (RA) diagnosis. We also aimed to locate and quantify disease and diagnostic information recorded only in text
Setting: UK general practice patient records from the Clinical Practice Research Datalink.
Participants: 294 individuals with incident diagnosis of RA between 2005 and 2008; 204 women and 85 men, median age 63 years.
Primary and Secondary Outcome Measures: Assessment of 1) quantity and timing of text entries for disease modifying anti-rheumatic drugs (DMARDs) as a proxy for the RA disease code, and 2) quantity, location and timing of free text information relating to RA onset and diagnosis.
Results: Inflammatory markers, pain and DMARDs were the most common categories of disease information in text prior to RA diagnostic code; 10-37% of patients had such information only in text. Read codes associated with RA-related text included correspondence, general consultation, and arthritis codes. 64 patients (22%) had DMARD text entries >14 days prior to RA code; these patients had more and earlier referrals to rheumatology, tests, swelling, pain, and DMARD prescriptions, suggestive of an earlier implicit diagnosis than was recorded by the diagnostic code.
Conclusions: RA-related symptoms, tests, referrals and prescriptions were recorded in free text with 22% of patients showing strong evidence of delay in coding of diagnosis. Researchers using EHRs may need to mitigate for delayed codes by incorporating text into their case-ascertainment strategies. Natural language processing techniques have the capability to do this at scale.

Item Type: Article
Keywords: Rheumatoid arthritis, Electronic health records, Data quality, General practice
Schools and Departments: Brighton and Sussex Medical School > Clinical Medicine
Brighton and Sussex Medical School > Primary Care and Public Health
School of Engineering and Informatics > Informatics
Subjects: R Medicine
R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine
Related URLs:
Depositing User: Elizabeth Ford
Date Deposited: 06 May 2016 09:19
Last Modified: 30 Apr 2017 07:50
URI: http://sro.sussex.ac.uk/id/eprint/60787

View download statistics for this item

📧 Request an update
Project NameSussex Project NumberFunderFunder Ref
The ergonomics of electric patient records: an interdisciplinary development of methodologies for understanding and exploiting free text to enhance the utility of primary care electronic patient recordsG0011WELLCOME TRUST086105/Z/08/Z