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Aligning EHR Data for Pediatric Leukemia With Standard Protocol Therapy.

Nicole M Wood1,2,3, Sierra Davis2, Karen Lewing1,3

  • 1Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO.

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|March 3, 2021
PubMed
Summary
This summary is machine-generated.

Electronic health records reveal that most pediatric cancer centers align with Children's Oncology Group (COG) guidelines for acute lymphoblastic leukemia (ALL) treatment milestones. This study highlights the utility of aggregate EHR data for evaluating real-world clinical practice in pediatric oncology.

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Area of Science:

  • Pediatric Oncology
  • Health Informatics
  • Clinical Trial Management

Background:

  • Children with acute lymphoblastic leukemia (ALL) are treated using risk-based protocols from the Children's Oncology Group (COG).
  • Understanding the alignment between real-world clinical practice and COG protocol milestones is crucial but not well-established.
  • Aggregate deidentified electronic health record (EHR) data present an opportunity to assess clinical practice in real-world settings.

Purpose of the Study:

  • To evaluate the alignment of real-world clinical practice with established Children's Oncology Group (COG) protocol milestones for pediatric acute lymphoblastic leukemia (ALL).
  • To assess the utility of aggregate deidentified electronic health record (EHR) data in understanding clinical practice variations and adherence to treatment guidelines.

Main Methods:

  • A cohort of pediatric ALL patients was identified using Cerner Health Facts deidentified aggregate EHR data.
  • Automated methods were developed to classify standard-risk precursor B-cell ALL patients, with manual review for procedural milestones.
  • Milestone procedures, specifically lumbar punctures (LP), were analyzed relative to therapy initiation and aligned with COG standard induction therapy protocols.

Main Results:

  • The study identified 7,728 pediatric ALL patients across 188,187 encounters.
  • Lumbar puncture (LP) and bone marrow biopsy records were sufficiently present to evaluate guideline adherence.
  • Analysis of 14 health systems showed that while not all systems had data for all recommended LP procedures, most demonstrated adherence to recommended timing for LPs.

Conclusions:

  • Variations in data sources can lead to inconsistencies in aggregate EHR data, necessitating careful data interpretation and visualization.
  • Despite data limitations, health systems showed strong alignment with recommended lumbar puncture (LP) milestones for pediatric ALL patients.
  • Large-scale aggregate EHR data are valuable for assessing the concordance between recommended and actual clinical milestones in pediatric ALL treatment, informing future guideline development.