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Linking the Virtual Pediatric System and Pediatric Hospital Information System Databases to Create Novel PICU
Brian F Flaherty1, Seth Otto2, Cody S Olsen2
1Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT.
Insights
A new method successfully linked Virtual Pediatric System (VPS) and Pediatric Health Information System (PHIS) data from 31 hospitals without protected health information (PHI). This creates a robust database for pediatric intensive care unit (PICU) research.
Area of Science:
- Health Informatics
- Pediatric Critical Care Medicine
- Data Science
Background:
- A significant gap exists in national pediatric intensive care unit (PICU) databases, hindering crucial epidemiologic and quasi-experimental research.
- Previous attempts to combine the Virtual Pediatric System (VPS) and Pediatric Health Information System (PHIS) databases were limited by restrictions on using protected health information (PHI).
- This study aimed to link VPS and PHIS records from 31 hospitals while strictly avoiding the use of PHI.
Purpose of the Study:
- To develop and validate a method for linking the Virtual Pediatric System (VPS) and Pediatric Health Information System (PHIS) databases without utilizing protected health information (PHI).
- To establish a comprehensive and accurate combined dataset suitable for pediatric intensive care unit (PICU) research.
- To overcome data limitations hindering large-scale research in pediatric critical care.
Main Methods:
- A sequential direct plus probabilistic linkage approach was employed using de-identified records from 31 hospitals for patients discharged between January 1, 2017, and December 31, 2022.
- Directly linked records served as a reference to assess the accuracy of probabilistic linkage, evaluating false-negative and false-positive rates.
- Demographic and clinical variables were compared between linked and unlinked records using Cohen's Effect Size (CES) to ensure data integrity.
Main Results:
- A total of 337,836 VPS and 3,515,595 PHIS records were processed without PHI.
- The linkage successfully connected 94.7% (319,955) of VPS records, with direct linkage accounting for 85.7% and probabilistic linkage for 14.3%.
- Probabilistic linkage demonstrated high accuracy with 0.21% false-negative links and no false-positive links, showing negligible differences in key patient characteristics between linked and unlinked data.
Conclusions:
- A highly accurate linkage between VPS and PHIS database records was achieved from 31 hospitals using a combined direct and probabilistic approach, without compromising patient privacy (PHI).
- The resulting integrated database provides a valuable, de-identified resource for conducting novel and robust research in pediatric intensive care unit (PICU) settings.
- This methodology overcomes previous data limitations, paving the way for enhanced epidemiologic and clinical studies in pediatric critical care.
Background:
Lack of a robust, national PICU database hinders epidemiologic and quasi-experimental research of PICU care. Combining the virtual pediatric system (VPS) and pediatric health information system (PHIS) databases would overcome this data gap. However, limits on the use of variables containing protected health information (PHI) have prevented prior large-scale VPS-PHIS linkage. We sought to link VPS and PHIS records from 31 hospitals without using PHI.
Methods:
We performed a database linkage study utilizing a sequential direct + probabilistic linkage approach with records from 31 hospitals contributing to VPS and PHIS for patients discharged between January 1, 2017 and December 31, 2022. Using directly linked records as a reference, we assessed the accuracy of probabilistically linked pairs with data from four hospitals by describing the percent of false-negative and false-positive links. We also compared demographic and clinical variables between linked and unlinked records using Cohen's Effect size (CES).
Results:
We obtained 337,836 VPS and 3,515,595 PHIS records without PHI. In total, we linked 319,955 of 337,836 (94.7%) VPS records. Direct linkage contributed 274,345 of 319,955 (85.7%) of all record linkages. Probabilistic linkage contributed 45,610 of 319,955 (14.3%) of all record linkages. Assessment of the probabilistic linkage found 0.21% false-negative links and no false-positive links. We found negligible imbalance by CES for gender (% female in linked vs. unlinked: 44.8% vs. 43.6%, CES 0.024), age in years (median [interquartile range (IQR)]: 5.1 [1.21-13.22] vs. 5.53 [1.53-13.38], CES 0.054), Pediatric Risk of Mortality 3 score (median [IQR]: 0.44 [0.3-0.9] vs. 0.37 [0.29-1.02], CES 0.096), or days in PICU (median [IQR]: 1.55 [0.8-3.47] vs. 1.33 [0.79-3.45], CES 0.031).
Conclusions:
Using a combined direct and probabilistic linkage approach, we created a highly accurate linkage VPS and PHIS database records from 31 hospitals without using PHI. This combined database can be used to create novel datasets for PICU research.
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