Accurate case finding using linked electronic clinical and administrative data at a children's hospital
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Published on: September 20, 2018
P P Breitfeld1, T Dale, J Kohne
1Department of Pediatrics, Indiana University School of Medicine, 702 Barnhill Drive, Indianapolis, IN 46202, USA. breit003@mc.duke.edu
Insights
Linking hospital administrative and electronic medical record data effectively identifies children with cancer experiencing fever and neutropenia. This integrated approach improves case-finding accuracy compared to using administrative data alone.
Area of Science:
- Pediatric Oncology
- Health Informatics
- Data Management
Background:
- Accurate identification of pediatric cancer patients with fever and neutropenia is crucial for timely intervention.
- Hospital administrative data and electronic medical records (EMRs) contain valuable but often siloed patient information.
- Effective data linkage is needed to leverage these resources for improved clinical case finding.
Purpose of the Study:
- To link hospital administrative data with EMR data at a children's hospital.
- To identify pediatric cancer patients admitted for fever and neutropenia using linked data.
- To evaluate the accuracy of this integrated case-finding strategy.
Main Methods:
- Hospital administrative data from 13,374 encounters were linked with EMR clinical data.
- Data validation was performed to ensure accuracy of the linked records.
- Case-finding sensitivity and specificity were calculated and compared to administrative data alone.
Main Results:
- Successful linkage of administrative and clinical records was achieved in 99% of cases.
- The integrated case-finding strategy demonstrated high sensitivity (73.1%) and specificity (99.6%).
- Using administrative data alone resulted in significantly lower sensitivity and specificity (P < 0.01).
Conclusions:
- Linking children's hospital administrative and clinical data systems is feasible.
- This integrated approach enhances the accuracy of identifying specific patient cohorts, such as those with fever and neutropenia.
- The method offers a valuable tool for managing common and costly conditions in pediatric healthcare.
Abstract:
To link hospital administrative data and an electronic medical record at a children's hospital in order to identify children with cancer admitted for fever and neutropenia. Hospital administrative data concerning 13,374 inpatient and outpatient encounters were validated against and linked to clinical data stored in an electronic medical record. Queries of the linked databases identified children with fever and neutropenia. Sensitivity and specificity of the experimental case-finding strategy were determined and compared to a control case-finding strategy utilizing administrative data alone. Linking of the clinical record to the administrative record was achieved in 233 (99%) of the 235 records. Of 1680 data elements reviewed from the administrative data that were also potentially available in the clinical data system, 1679 (99.9%) were verified in the electronic medical record. The experimental strategy for case finding had a sensitivity of 73.1% (95% CI: 58.1, 88.3), specificity 99.6% (95% CI: 99.1, 100). If only administrative data such as diagnosis-related group and hospital service were used for case finding, both the sensitivity (P < 0.01) and specificity (P < 0.01) were significantly lower. Linking a children's hospital administrative data system with clinical data is feasible and can be utilized for specific case finding for a common and costly condition in children.
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