TY - JOUR
T1 - Optimising case detection within UK electronic health records
T2 - use of multiple linked databases for detecting liver injury
AU - Wing, Kevin
AU - Bhaskaran, Krishnan
AU - Smeeth, Liam
AU - van Staa, Tjeerd P.
AU - Klungel, Olaf H.
AU - Reynolds, Robert F.
AU - Douglas, Ian
N1 - Funding Information:
KW and OHK specified receiving grants from PROTECT (http://www. imi-protect.eu/) during the study. The PROTECT project has received support from the Innovative Medicine Initiative Joint Undertaking (http://www.imi. europa.eu) under grant agreement number 115004, resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and European Federation of Pharmaceutical Industries & Associations (EFPIA) companies' kind contribution. Additional funding sources are as follows: ID is funded by an MRC methodology fellowship (grant number G0802403), KB holds a Sir Henry Dale fellowship jointly funded by the Wellcome Trust and the Royal Society and LS is funded by a Wellcome Trust Senior Clinical Fellowship and is an NIHR Senior Investigator (grant number WT-098504/Z/12/Z and PO 481810). In the context of the IMI Joint Undertaking (IMI JU), the London School of Hygiene and Tropical Medicine (KW)/Department of Pharmacoepidemiology, Utrecht University (OHK) received direct financial contributions from Pfizer.
Funding Information:
Funding KW and OHK specified receiving grants from PROTECT (http://www. imi-protect.eu/) during the study. The PROTECT project has received support from the Innovative Medicine Initiative Joint Undertaking (http://www.imi. europa.eu) under grant agreement number 115004, resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007–2013) and European Federation of Pharmaceutical Industries & Associations (EFPIA) companies’ kind contribution. Additional funding sources are as follows: ID is funded by an MRC methodology fellowship (grant number G0802403), KB holds a Sir Henry Dale fellowship jointly funded by the Wellcome Trust and the Royal Society and LS is funded by a Wellcome Trust Senior Clinical Fellowship and is an NIHR Senior Investigator (grant number WT—098504/Z/12/Z and PO 481810). In the context of the IMI Joint Undertaking (IMI JU), the London School of Hygiene and Tropical Medicine (KW)/Department of Pharmacoepidemiology, Utrecht University (OHK) received direct financial contributions from Pfizer.
Publisher Copyright:
© 2016 BMJ Publishing Group. All rights reserved.
PY - 2016/9/2
Y1 - 2016/9/2
N2 - Objectives: We aimed to create a 'multidatabase' algorithm for identification of cholestatic liver injury using multiple linked UK databases, before (1) assessing the improvement in case ascertainment compared to using a single database and (2) developing a new single-database case-definition algorithm, validated against the multidatabase algorithm. Design: Method development for case ascertainment. Setting: Three UK population-based electronic health record databases: the UK Clinical Practice Research Datalink (CPRD), the UK Hospital Episodes Statistics (HES) database and the UK Office of National Statistics (ONS) mortality database. Participants: 16 040 people over the age of 18 years with linked CPRD-HES records indicating potential cholestatic liver injury between 1 January 2000 and 1 January 2013. Primary outcome measures: (1) The number of cases of cholestatic liver injury detected by the multidatabase algorithm. (2) The relative contribution of each data source to multidatabase case status. (3) The ability of the new single-database algorithm to discriminate multidatabase algorithm case status. Results: Within the multidatabase case identification algorithm, 4033 of 16 040 potential cases (25%) were identified as definite cases based on CPRD data. HES data allowed possible cases to be discriminated from unlikely cases (947 of 16 040, 6%), but only facilitated identification of 1 definite case. ONS data did not contribute to case definition. The new single-database (CPRD-only) algorithm had a very good ability to discriminate multidatabase case status (area under the receiver operator characteristic curve 0.95). Conclusions: CPRD-HES-ONS linkage confers minimal improvement in cholestatic liver injury case ascertainment compared to using CPRD data alone, and a multidatabase algorithm provides little additional information for validation of a CPRD-only algorithm. The availability of laboratory test results within CPRD but not HES means that algorithms based on CPRD-HES-linked data may not always be merited for studies of liver injury, or for other outcomes relying primarily on laboratory test results.
AB - Objectives: We aimed to create a 'multidatabase' algorithm for identification of cholestatic liver injury using multiple linked UK databases, before (1) assessing the improvement in case ascertainment compared to using a single database and (2) developing a new single-database case-definition algorithm, validated against the multidatabase algorithm. Design: Method development for case ascertainment. Setting: Three UK population-based electronic health record databases: the UK Clinical Practice Research Datalink (CPRD), the UK Hospital Episodes Statistics (HES) database and the UK Office of National Statistics (ONS) mortality database. Participants: 16 040 people over the age of 18 years with linked CPRD-HES records indicating potential cholestatic liver injury between 1 January 2000 and 1 January 2013. Primary outcome measures: (1) The number of cases of cholestatic liver injury detected by the multidatabase algorithm. (2) The relative contribution of each data source to multidatabase case status. (3) The ability of the new single-database algorithm to discriminate multidatabase algorithm case status. Results: Within the multidatabase case identification algorithm, 4033 of 16 040 potential cases (25%) were identified as definite cases based on CPRD data. HES data allowed possible cases to be discriminated from unlikely cases (947 of 16 040, 6%), but only facilitated identification of 1 definite case. ONS data did not contribute to case definition. The new single-database (CPRD-only) algorithm had a very good ability to discriminate multidatabase case status (area under the receiver operator characteristic curve 0.95). Conclusions: CPRD-HES-ONS linkage confers minimal improvement in cholestatic liver injury case ascertainment compared to using CPRD data alone, and a multidatabase algorithm provides little additional information for validation of a CPRD-only algorithm. The availability of laboratory test results within CPRD but not HES means that algorithms based on CPRD-HES-linked data may not always be merited for studies of liver injury, or for other outcomes relying primarily on laboratory test results.
UR - http://www.scopus.com/inward/record.url?scp=85019996090&partnerID=8YFLogxK
U2 - 10.1136/BMJOPEN-2016-012102
DO - 10.1136/BMJOPEN-2016-012102
M3 - Article
C2 - 27591023
AN - SCOPUS:85019996090
SN - 2044-6055
VL - 6
JO - BMJ Open
JF - BMJ Open
IS - 9
M1 - e012102
ER -