Determining Diagnosis Date of Diabetes Using Structured Electronic Health Record (EHR) Data: The SEARCH for Diabetes in Youth Study

Abstract Background. Disease surveillance of diabetes among youth has relied mainly upon manual chart review. However, increasingly available structured electronic health record (EHR) data have been shown to yield accurate determinations of diabetes status and type. Validated algorithms to determine date of diabetes diagnosis are lacking. The objective of this work is to validate two EHR-based algorithms to determine date of diagnosis of diabetes.Methods. A rule-based ICD-10 algorithm identified youth with diabetes from structured EHR data over the period of 2009 through 2017 within three children’s hospitals that participate in the SEARCH for Diabetes in Youth Study: Cincinnati Children’s Hospital, Cincinnati, OH, Seattle Children’s Hospital, Seattle, WA, and Children’s Hospital Colorado, Denver, CO. Previous research and a multidisciplinary team informed the creation of two algorithms based upon structured EHR data to determine date of diagnosis among diabetes cases. An ICD-code algorithm was defined by the year of occurrence of second ICD-9 or ICD-10 diabetes code. A multiple-criteria algorithm consisted of the year of first occurrence of any of the following: diabetes-related ICD code, elevated glucose, elevated HbA1c, or diabetes medication. We assessed algorithm performance by percent agreement with a gold standard date of diagnosis determined by chart review. Results. Among 3777 cases, both algorithms demonstrated high agreement with true diagnosis year and differed in classification (p=0.006): 86.5% agreement for the ICD code algorithm and 85.9% agreement for the multiple-criteria algorithm. Agreement was high for both type 1 and type 2 cases for the ICD code algorithm. Performance improved over time. Conclusions. Year of occurrence of the second ICD diabetes-related code in the EHR yields an accurate diagnosis date within these pediatric hospital systems. This may lead to increased efficiency and sustainability of surveillance methods for incidence of diabetes among youth.

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Determining diagnosis date of diabetes using structured electronic health record (EHR) data: the SEARCH for diabetes in youth study

BMC Medical Research Methodology ◽

10.1186/s12874-021-01394-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kristin M. Lenoir ◽

Lynne E. Wagenknecht ◽

Jasmin Divers ◽

Ramon Casanova ◽

Dana Dabelea ◽

...

Keyword(s):

Chart Review ◽

Health Record ◽

Algorithm Performance ◽

Children's Hospital ◽

Code Algorithm ◽

Children’S Hospital ◽

Icd 10 ◽

Youth Study ◽

Diagnosis Date ◽

Diabetes In Youth

Abstract Background Disease surveillance of diabetes among youth has relied mainly upon manual chart review. However, increasingly available structured electronic health record (EHR) data have been shown to yield accurate determinations of diabetes status and type. Validated algorithms to determine date of diabetes diagnosis are lacking. The objective of this work is to validate two EHR-based algorithms to determine date of diagnosis of diabetes. Methods A rule-based ICD-10 algorithm identified youth with diabetes from structured EHR data over the period of 2009 through 2017 within three children’s hospitals that participate in the SEARCH for Diabetes in Youth Study: Cincinnati Children’s Hospital, Cincinnati, OH, Seattle Children’s Hospital, Seattle, WA, and Children’s Hospital Colorado, Denver, CO. Previous research and a multidisciplinary team informed the creation of two algorithms based upon structured EHR data to determine date of diagnosis among diabetes cases. An ICD-code algorithm was defined by the year of occurrence of a second ICD-9 or ICD-10 diabetes code. A multiple-criteria algorithm consisted of the year of first occurrence of any of the following: diabetes-related ICD code, elevated glucose, elevated HbA1c, or diabetes medication. We assessed algorithm performance by percent agreement with a gold standard date of diagnosis determined by chart review. Results Among 3777 cases, both algorithms demonstrated high agreement with true diagnosis year and differed in classification (p = 0.006): 86.5% agreement for the ICD code algorithm and 85.9% agreement for the multiple-criteria algorithm. Agreement was high for both type 1 and type 2 cases for the ICD code algorithm. Performance improved over time. Conclusions Year of occurrence of the second ICD diabetes-related code in the EHR yields an accurate diagnosis date within these pediatric hospital systems. This may lead to increased efficiency and sustainability of surveillance methods for incidence of diabetes among youth.

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Determining Diagnosis Date of Diabetes Using Structured Electronic Health Record (EHR) Data: The SEARCH for Diabetes in Youth Study (Preprint)

10.2196/preprints.24324 ◽

2020 ◽

Author(s):

Kristin M Lenoir ◽

Lynne E Wagenknecht ◽

Jasmin Divers ◽

Ramon Casanova ◽

Jean M Lawrence ◽

...

Keyword(s):

Electronic Health Record ◽

Multiple Criteria ◽

Health Record ◽

Diabetes Diagnosis ◽

Diabetes Status ◽

Code Algorithm ◽

Icd 10 ◽

Youth Study ◽

Diagnosis Date ◽

Diabetes In Youth

BACKGROUND Manual chart review remains the primary method to identify diabetes status, diabetes type, and date of onset. Previous work determined that increasingly available structured electronic health record (EHR) data can accurately determine diabetes status and type. Validated algorithms to determine date of diabetes diagnosis are lacking. OBJECTIVE To validate two EHR-based algorithms to determine date of diabetes diagnosis to make incidence surveillance more efficient and sustainable. METHODS A rule-based ICD-10 algorithm identified youth with diabetes among three children’s hospitals in Ohio, Washington, and Colorado participating in the SEARCH for Diabetes in Youth Study. Two date of diagnosis algorithms were compared to the chart-reviewed gold standard among cases detected in the EHR from 2009 through 2017: year of occurrence of second ICD-9 or ICD-10 diabetes code (ICD code), and year of first occurrence of any of the following criteria: ICD diabetes code, elevated glucose, elevated HbA1c, or diabetes medication (multiple-criteria). RESULTS Among 3777 cases, the algorithms demonstrated high agreement with true diagnosis year and differed in classification (p=.006): 86.5% agreement for ICD code algorithm and 85.9% agreement for multiple-criteria algorithm. Agreement was high for both type 1 and type 2 cases for the ICD code algorithm. Performance improved over time. CONCLUSIONS Year of occurrence of second ICD diabetes code yields an accurate diagnosis date within these pediatric hospital systems leading to increased efficiency of surveillance methods. CLINICALTRIAL not applicable

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Surgical Techniques for Tonsillectomy and Perioperative Respiratory Complications in Children

Otolaryngology ◽

10.1177/01945998211015176 ◽

2021 ◽

pp. 019459982110151

Author(s):

Rahul G. Baijal ◽

Karla E. Wyatt ◽

Teniola Shittu ◽

Eugenia Y. Chen ◽

Eric Z. Wei ◽

...

Keyword(s):

Surgical Technique ◽

Chart Review ◽

Surgical Techniques ◽

Retrospective Chart Review ◽

Airway Disease ◽

Respiratory Complications ◽

Patient Factors ◽

Children's Hospital ◽

Reactive Airway Disease ◽

Children’S Hospital

Objectives The aim of this study was to determine the incidence of perioperative respiratory complications in children following tonsillectomy with cold and hot dissection surgical techniques. Study Design The study was a retrospective cohort study. Setting Retrospective chart review was performed for all children presenting for a tonsillectomy at Texas Children’s Hospital from November 2015 to December 2017. Methods Pre- and intraoperative patient factors, including surgical technique with cold or hot dissection (electrocautery or radiofrequency ablation), and perioperative anesthetic factors were collected to determine the incidence of perioperative respiratory complications. Results A total of 2437 patients underwent a tonsillectomy at Texas Children’s Hospital from November 2015 to December 2017. The incidence of perioperative respiratory complications was 20.0% (n = 487). Sickle cell disease, cardiac disease, reactive airway disease, pulmonary disease, age >2 and <3 years, and obesity, defined as a body mass index >95th percentile for age, were significant for overall perioperative respiratory complications. There was no difference in the incidence of perioperative respiratory complications in children undergoing tonsillectomy by cold or hot dissection. Conclusion Perioperative respiratory complications following tonsillectomy are more affected by patient factors than surgical technique.

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Palliative care is not associated with decreased intensity of care: Results of a chart review from a large children's hospital

Pediatric Blood & Cancer ◽

10.1002/pbc.29391 ◽

2021 ◽

Author(s):

Laura K. Sedig ◽

Jessica L. Spruit ◽

Jessica Southwell ◽

Trisha K. Paul ◽

Melissa K. Cousino ◽

...

Keyword(s):

Palliative Care ◽

Chart Review ◽

Children's Hospital ◽

Children’S Hospital ◽

Intensity Of Care

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A Retrospective Review of Hospital-Acquired Venous Thromboembolism at a Large Pediatric Tertiary Care Center

Blood ◽

10.1182/blood-2019-129398 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 3471-3471

Author(s):

Marissa A. Just ◽

Joanna Robles ◽

Karan R. Kumar ◽

Andrew Yazman ◽

Jennifer A. Rothman ◽

...

Keyword(s):

Retrospective Review ◽

Research Funding ◽

Pediatric Patients ◽

Central Venous ◽

Vte Prophylaxis ◽

Children's Hospital ◽

Congenital Cardiac Disease ◽

Children’S Hospital ◽

Icd 10 ◽

Hospital Acquired

Introduction: The incidence of venous thromboembolism (VTE) in hospitalized pediatric patients is increasing secondary to the growing medical complexity of pediatric patients and the increasing use of central venous catheters. Pediatric patients diagnosed with VTE have up to 2% mortality associated directly with their thromboses. While incidence, risk factor identification and preventive strategies are well established in hospitalized adults, this information is limited in the pediatric population. There are currently no standardized VTE risk screening tools or thromboprophylaxis guidelines for children at Duke Children's Hospital. The incidence of hospital acquired VTE (HA-VTE), as well as their associated risk factors were investigated in a retrospective review. Methods: Medical records of pediatric patients hospitalized at Duke Children's Hospital during June 2018 through November 2018 were reviewed. The EPIC SlicerDicer tool was used to identify patients with ICD-10 diagnoses codes related to thrombosis or treated with anticoagulants. Included patients were diagnosed with HA-VTE during their hospitalization or within 14 days of discharge. Data collected included demographics, thrombosis characteristics, family history, mobility, and acute or chronic co-morbid conditions. The characteristics of the study population were described by median (with 25th and 75th percentiles) for continuous variables and frequencies (with percentages) for binary or categorical variables. Results: Out of 4,176 total pediatric admissions to all units of Duke Children's Hospital (ages 0-18.99 years) during the inclusion timeframe, 33 VTE events were identified. The incidence of VTE events per 1000 patient days was 0.98. The complete patient and VTE event characteristics are listed in Tables 1 and 2. The median age of patients with VTE events was 0.4 years. Of the identified cohort, 73% had an associated central venous line (CVL). Neonates with congenital cardiac disease comprised the majority of the cohort. Other common patient characteristics observed in this cohort included impaired mobility, recent major surgery, and recent mechanical ventilation. Of the 33 VTE diagnoses, 70% received therapeutic anticoagulation with enoxaparin or unfractionated heparin. Only 2 patients (8%) received prophylactic anticoagulation prior to their diagnosis of VTE. Conclusions: The retrospective review of HA-VTE events at Duke Children's Hospital identified that the majority of the events occurred in neonates with congenital cardiac disease and the presence of CVLs. It was also noted that there was no standardization among the use of anticoagulation agents that were initiated for treatment of VTE. Furthermore, few patients received VTE prophylaxis during the hospitalization. A limitation of this review was that it was retrospective and the documentation of family history of thrombosis was inconsistent. It is also possible that several VTE events were missed due to inadequate ICD-10 coding. Based on the results of this review, there is a need to implement a risk stratification tool and develop standardized recommendations of VTE prophylaxis and treatments for pediatric patients admitted to Duke Children's Hospital. There is an additional quality improvement phase of this project and the goal is to implement a risk calculator that is based on information learned from the retrospective review. Ultimately, this risk calculator will help to decrease the incidence of VTE events at Duke Children's Hospital. Disclosures Rothman: Agios: Honoraria, Research Funding; Pfizer: Consultancy, Honoraria, Research Funding; Novartis: Honoraria, Research Funding.

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Detection of Diabetes Status and Type in Youth using Electronic Health Records (EHRs): The SEARCH for Diabetes in Youth Study

10.2337/figshare.12558875.v1 ◽

2020 ◽

Author(s):

Brian J. Wells ◽

Kristin M. Lenoir ◽

Lynne E. Wagenknecht ◽

Elizabeth J. Mayer-Davis ◽

Jean M. Lawrence ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Multinomial Regression ◽

Rule Based ◽

Diabetes Status ◽

Icd 10 ◽

Youth Study ◽

Diabetes In Youth

Objective: Diabetes surveillance often requires manual medical chart reviews to confirm status and type. This project aimed to create an electronic health record (EHR)-based procedure for improving surveillance efficiency through automation of case identification. Research Design and Methods: Youth (< 20 years) with potential evidence of diabetes (N=8,682) were identified from EHRs at three children’s hospitals participating in the SEARCH for Diabetes in Youth Study. True diabetes status/type was determined by manual chart reviews. Multinomial regression was compared with an ICD-10 rule-based algorithm in the ability to correctly identify diabetes status and type. Subsequently, the investigators evaluated a scenario of combining the rule based algorithm with targeted chart reviews where the algorithm performed poorly. Results: The sample included 5308 true cases (89.2% type 1 diabetes). The rule-based algorithm outperformed regression for overall accuracy (0.955 vs 0.936). Type 1 diabetes was classified well by both methods: sensitivity (Se) (>0.95), specificity (Sp) (>0.96), and positive predictive value (PPV) (>0.97). In contrast, the PPVs for type 2 diabetes were 0.642 and 0.778 for the rule-based algorithm and the multinomial regression, respectively. Combining the rule-based method with chart reviews (n=695, 7.9%) of persons predicted to have non type 1 diabetes resulted in perfect PPV for the cases reviewed, while increasing overall accuracy (0.983). The sensitivity, specificity, and PPV for type 2 diabetes using the combined method were >=0.91. Conclusions: An ICD-10 algorithm combined with targeted chart reviews accurately identified diabetes status/type and could be an attractive option for diabetes surveillance in youth.

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Impact of the meaningful use incentive program on electronic health record adoption by US children's hospitals

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocu045 ◽

2015 ◽

Vol 22 (2) ◽

pp. 390-398 ◽

Cited By ~ 7

Author(s):

Mari M. Nakamura ◽

Marvin B. Harper ◽

Allan V. Castro ◽

Feliciano B. Yu ◽

Ashish K. Jha

Keyword(s):

Electronic Health Record ◽

Meaningful Use ◽

Pediatric Care ◽

Health Record ◽

Children's Hospitals ◽

Children's Hospital ◽

Incentive Program ◽

Children’S Hospitals ◽

Children’S Hospital ◽

Electronic Health

Abstract Objective We determined adoption rates of pediatric-oriented electronic health record (EHR) features by US children's hospitals and assessed perceptions regarding the suitability of commercial EHRs for pediatric care and the influence of the meaningful use incentive program on implementation of pediatric-oriented features. Materials and Methods We surveyed members of the Children's Hospital Association. We measured adoption of 19 pediatric-oriented features and asked whether commercial EHRs include key pediatric-focused capabilities. We inquired about the meaningful use program's relevance to pediatrics and its influence on EHR implementation priorities. Results Of 164 general acute care children's hospitals, 100 (61%) responded to the survey. Rates of comprehensive (across all pediatric units) adoption ranged from 37% (age-, gender-, and weight-adjusted blood pressure percentiles and immunization contraindication warnings) to 87% (age in appropriate units). Implementation rates for several features varied significantly by children's hospital type. Nearly 60% of hospitals reported having EHRs that do not contain all features essential for high-quality care. A majority of hospitals indicated that the meaningful use program has had no effect on their adoption of pediatric features, while 26% said they have delayed or forgone incorporation of such features because of the program. Conclusions Children's hospitals are implementing pediatric-focused features, but a sizable proportion still finds their systems suboptimal for pediatric care. The meaningful use incentive program is failing to promote and in some cases delaying uptake of pediatric-oriented features.

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VP147 Implementing Electronic Health Record In A Children's Hospital

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462317003919 ◽

2017 ◽

Vol 33 (S1) ◽

pp. 216-217

Author(s):

Martina Andellini ◽

Francesco Faggiano ◽

Francesca Sabusco ◽

Pietro Derrico ◽

Matteo Ritrovato

Keyword(s):

Electronic Health Record ◽

Healthcare Delivery ◽

Legal Aspects ◽

Health Record ◽

Privacy And Security ◽

Children's Hospital ◽

Organizational Outcome ◽

Children’S Hospital ◽

Electronic Health ◽

The Impact

INTRODUCTION:Since the adoption of electronic health record (EHR) systems, which contain large volumes of aggregated longitudinal clinical data, promises a number of substantial benefits including better care, improved safety issues and decreased healthcare costs (1). It is also associated with significant costs and large technical and organizational impacts, therefore it is important to conduct comprehensive evaluations of healthcare delivery outcomes. The purpose of the study is to gather evidence on safety and overall effectiveness of EHR implementation in Bambino Gesù Children's Hospital (OPBG).METHODS:Decision-oriented HTA (DoHTA) method (2) was applied to assess the technology on clinical, technical, organizational, economic, legal, ethical and safety domains. It's a new implementation of the European Network for Health Technology Assessment (EUnetHTA) CoreModel integrated with the Analytic Hierarchy Process. It allows defining an evaluation structure represented by a hierarchical decision tree filled by indicators of technology's performances, each of which was given a weight proportional to the impact that this criterion provides to achieve the purpose of the decision problem; finally, the alternatives’ ranking was defined.RESULTS:The multidisciplinary assessment took into consideration all of the aspects and recommendations about the benefits and disadvantages of EHR (3). The synthesis of scientific evidence integrated with results of the specific context analysis, resulted in the definition of components of the decisional hierarchy structure. In particular, EHR seems to offer many benefits in terms of safety and clinical effectiveness such as improved continuity and quality of care, and increased accessibility of the data. The implementation of EHR resulted in important organizational outcome such as EHR configuration, learning curve and training. For these reasons, the usability was the main technical characteristics of the technology taken into account. Finally, legal aspects on privacy and security of data, covered a key role in the assessment.CONCLUSIONS:A thorough evaluation of the EHR before its implementation has permitted hospital's decision makers to choose knowingly.

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