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首页> 外文期刊>Journal of public health management and practice: JPHMP >Comparison of electronic laboratory reports, administrative claims, and electronic health record data for acute viral hepatitis surveillance
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Comparison of electronic laboratory reports, administrative claims, and electronic health record data for acute viral hepatitis surveillance

机译：比较电子实验室报告，行政声明和电子健康记录数据以进行急性病毒性肝炎监测

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Context: Public health surveillance systems for acute hepatitis are limited: clinician reporting is insensitive and electronic laboratory reporting is nonspecific. Insurance claims and electronic health records are potential alternative sources. Objective: To compare the utility of laboratory data, diagnosis codes, and electronic health record combination data (current and prior viral hepatitis studies, liver function tests, and diagnosis codes) for acute hepatitis A and B surveillance. Design: Retrospective chart review. Setting: Massachusetts ambulatory practice serving 350 000 patients per year. Participants: All patients seen between 1990 and 2008. Main Outcome Measures: Sensitivity and positive predictive value of immunoglobulin M (IgM), International Classification of Disease-Ninth Revision (ICD-9) diagnosis codes, and combination electronic health record data for acute hepatitis A and B. Results: During the study period, there were 111 patients with positive hepatitis A IgMs, 154 with acute hepatitis A ICD-9 codes, and 77 with positive IgM and elevated liver function tests. On review, 79 cases were confirmed. Sensitivity and positive predictive value were 100% and 71% (95% confidence interval, 62%-79%) for IgM, 94% (92%-100%) and 48% (40%-56%) for ICD-9 codes and 97% (92%-100%) and 100% (96%-100%) for combination electronic health record data. There were 14 patients with positive hepatitis B core IgMs, 2564 with acute hepatitis B ICD-9 codes, and 125 with suggestive combinations of electronic health record data. Acute hepatitis B was confirmed in 122 patients. Sensitivity and positive predictive value were 9.4% (5.2%-16%) and 86% (60%-98%) for hepatitis B core IgM, 73% (65%-80%) and 3.6% (2.9%-4.4%) for ICD-9 codes, and 96% (91%-99%) and 98% (94%-99%) for electronic health record data. Conclusions: Laboratory surveillance using IgM tests overestimates the burden of acute hepatitis A and underestimates the burden of acute hepatitis B. Claims data are subject to many false positives. Electronic health record data are both sensitive and predictive. Electronic health record-based surveillance systems merit development.
机译：背景：急性肝炎的公共卫生监测系统有限：临床医生的报告不灵敏，电子实验室报告不明确。保险索赔和电子健康记录是潜在的替代来源。目的：比较实验室数据，诊断代码和电子健康记录组合数据（当前和先前的病毒性肝炎研究，肝功能检查和诊断代码）在急性甲型和乙型肝炎监测中的效用。设计：回顾性图表审查。地点：马萨诸塞州的门诊服务每年为35万名患者提供服务。参加者：1990年至2008年之间就诊的所有患者。主要观察指标：免疫球蛋白M（IgM）的敏感性和阳性预测价值，国际疾病分类第九次修订版（ICD-9）诊断代码以及急性肝炎的综合电子健康记录数据A和B。结果：在研究期间，有111例甲型肝炎IgMs阳性，154例急性A型肝炎ICD-9编码，77例IgM阳性和肝功能检查阳性。审查中，确认了79例。 IgM的敏感性和阳性预测值分别为100％和71％（95％置信区间，62％-79％），ICD-9编码为94％（92％-100％）和48％（40％-56％）和97％（92％-100％）和100％（96％-100％）的组合电子健康记录数据。乙型肝炎核心IgM阳性的患者14例，急性乙型肝炎ICD-9编码的患者2564例，电子健康记录数据的提示组合为125例。在122名患者中确认了急性乙型肝炎。乙型肝炎核心IgM的敏感性和阳性预测值分别为9.4％（5.2％-16％）和86％（60％-98％），73％（65％-80％）和3.6％（2.9％-4.4％）对于ICD-9代码，对于电子健康记录数据为96％（91％-99％）和98％（94％-99％）。结论：使用IgM测试的实验室监测高估了急性甲型肝炎的负担，而低估了急性乙型肝炎的负担。索赔数据存在许多假阳性。电子病历数据既敏感又可预测。基于电子病历的监视系统值得发展。

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