Validation of asthma recording in electronic health records: a systematic review

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Title: Validation of asthma recording in electronic health records: a systematic review
Authors: Nissen, F
Quint, JK
Wilkinson, S
Mullerova, H
Smeeth, L
Douglas, I
Item Type: Journal Article
Abstract: Objective: To describe the methods used to validate asthma diagnoses in electronic health records and summarize the results of the validation studies. Background: Electronic health records are increasingly being used for research on asthma to inform health services and health policy. Validation of the recording of asthma diagnoses in electronic health records is essential to use these databases for credible epidemiological asthma research. Methods: We searched EMBASE and MEDLINE databases for studies that validated asthma diagnoses detected in electronic health records up to October 2016. Two reviewers independently assessed the full text against the predetermined inclusion criteria. Key data including author, year, data source, case definitions, reference standard, and validation statistics (including sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) were summarized in two tables. Results: Thirteen studies met the inclusion criteria. Most studies demonstrated a high validity using at least one case definition (PPV >80%). Ten studies used a manual validation as the reference standard; each had at least one case definition with a PPV of at least 63%, up to 100%. We also found two studies using a second independent database to validate asthma diagnoses. The PPVs of the best performing case definitions ranged from 46% to 58%. We found one study which used a questionnaire as the reference standard to validate a database case definition; the PPV of the case definition algorithm in this study was 89%. Conclusion: Attaining high PPVs (>80%) is possible using each of the discussed validation methods. Identifying asthma cases in electronic health records is possible with high sensitivity, specificity or PPV, by combining multiple data sources, or by focusing on specific test measures. Studies testing a range of case definitions show wide variation in the validity of each definition, suggesting this may be important for obtaining asthma definitions with optimal validity.
Issue Date: 1-Dec-2017
Date of Acceptance: 11-Aug-2017
ISSN: 1179-1349
Publisher: Dove Medical Press
Start Page: 643
End Page: 656
Journal / Book Title: Clinical Epidemiology
Volume: 2017
Issue: 9
Copyright Statement: This work is published by Dove Medical Press Limited, and licensed under a Creative Commons Attribution License. The full terms of the License are available at The license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: NPV
1117 Public Health And Health Services
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine

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