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Research ArticleMethodology

Validating the 8 CPCSSN Case Definitions for Chronic Disease Surveillance in a Primary Care Database of Electronic Health Records

Tyler Williamson, Michael E. Green, Richard Birtwhistle, Shahriar Khan, Stephanie Garies, Sabrina T. Wong, Nandini Natarajan, Donna Manca and Neil Drummond
The Annals of Family Medicine July 2014, 12 (4) 367-372; DOI: https://doi.org/10.1370/afm.1644
Tyler Williamson
1Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
2Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
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  • For correspondence: tylerw@cpcssn.org
Michael E. Green
1Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
2Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
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Richard Birtwhistle
1Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
2Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
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Shahriar Khan
1Department of Family Medicine, Queen’s University, Kingston, Ontario, Canada
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Stephanie Garies
3Department of Family Medicine, University of Calgary, Alberta, Canada
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Sabrina T. Wong
4School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Nandini Natarajan
5Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Donna Manca
6Department of Family Medicine, University of Alberta, Alberta, Canada
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Neil Drummond
6Department of Family Medicine, University of Alberta, Alberta, Canada
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    Figure 1

    Sample inclusion and exclusion flow chart.

    APBRN = Atlantic Practice Based Research Network; BCPCReN = British Columbia Primary Research Care Network; MaRNet-FP = Maritme Family Practice Research Network; NAPCPReN = Northern Alberta Primary Care Research Network; SAPCReN = Southern Alberta Primary Care Research Network; UTOPIAN = University of Toronto Practice Based Research Network.

    a 350 Patients chosen at random, 25 patients case positive for epilepsy, 25 patients case positive for parkinsonism.

    b 175 Patients chosen at random, 13 patients case positive for epilepsy, 12 patients case positive for parkinsonism.

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    Table 1

    Summary of CPCSSN Case Definitions for 8 Index Conditions

    Case Definition
    ConditionInclusionsExclusions
    DiabetesDiabetes mellitus type 1 and type 2, controlled or uncontrolledGestational diabetes, chemically induced (secondary) diabetes, neonatal diabetes, polycystic ovarian syndrome, hyperglycemia, prediabetes, or similar states or conditions (such as impaired fasting glucose or glucose intolerance)
    HypertensionEssential hypertension, hypertensive heart disease, hypertensive chronic kidney disease, hypertensive heart and kidney disease, secondary hypertensionaMyocardial infarction, congestive heart failure, angina, portal hypertension, white-coat hypertension, gestational hypertension, or pregnancy-induced hypertension (unless there was a preexisting diagnosis of hypertension), borderline hypertension, or similar nonspecific comment
    COPDObstructive chronic bronchitis, emphysema, chronic airway obstruction (ever)bAll types of asthma, including chronic obstructive asthma
    DepressionEpisodic mood disorders, depressive disorder not elsewhere classified, bipolar, manic affective disorder, manic episodes, mild depression (not simply clinical depression)cAnxiety disorders, alcohol or drug-induced mental disorders, schizophrenic disorders, delusional disorders, other nonorganic psychoses, pervasive developmental disorders, or other intellectual disabilities
    OsteoarthritisOsteoarthritis and allied disorders, spondylosis and allied disorders such as kissing spine, ankylosing vertebral hyperostosisIntervertebral disc disorders, spinal stenosis, ankylosing spondylitis, and other inflammatory spondylopathies
    EpilepsyEpilepsy, recurrent seizures or general convulsions, petit mal (absence) seizures, grand mal (tonic-clonic) seizures, myoclonic epilepsy, childhood-onset epilepsy, childhood-related epilepsyProvoked seizure, alcohol withdrawal seizure, hypoglycemic seizure, or possible or suspected variants of the inclusionsd
    ParkinsonismParkinson disease, paralysis agitans, parkinsonismTremor, Wolf-Parkinson-White syndrome, and “suspected” or “possible” variants of the inclusions
    DementiaAlzheimer disease, frontotemporal dementia, Pick disease, senile degeneration of the brain, corticobasal degeneration, cerebral degeneration, dementia with Lewy bodies, mild cognitive impairment, senile dementia, presenile dementia, vascular dementia, senility without mention of psychosis
    • COPD = chronic obstructive pulmonary disease; CPCSSN = Canadian Primary Care Sentinel Surveillance Network.

    • ↵a Requires an explicit diagnosis of hypertension (eg, elevated blood pressure values alone are insufficient).

    • ↵b Only persons aged 35 years and older are eligible for inclusion. Classification of COPD requires more than a single x-ray or spirometry finding and must include either a specific or similar diagnosis of COPD.

    • ↵c This definition identifies lifetime prevalence.

    • ↵d Individuals with a diagnosis of petit mal, grand mal, or convulsions and not receiving antiepileptic drugs are excluded, along with individuals on antiepileptic drugs only and no diagnosis in the chart.

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    Table 2

    Summary of Patient Characteristics (n=1,920)

    Patient CharacteristicsPercent
    Male44.5
    Age ≥60 y85.4
    Disease prevalence
     Diabetes16.8
     Hypertension50.1
     Depression20.2
     COPD7.9
     Osteoarthritis31.6
     Dementia4.9
     Epilepsy7.3
     Parkinsonism4.3
    Number of chronic conditions (of 8 CPCSSN conditions)
     022.7
     134.6
     226.1
     3 or more16.6
    • COPD = chronic obstructive pulmonary disease; CPCSSN = Canadian Primary Care Sentinel Surveillance Network.

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    Table 3

    Summary of Validation Results

    ConditionSensitivity % (95% CI)Specificity % (95% CI)PPV % (95% CI)NPV % (95% CI)
    Hypertension84.9 (82.6–87.1)93.5 (92.0–95.1)92.9 (91.2–94.6)86.0 (83.9–88.2)
    Diabetes95.6 (93.4–97.9)97.1 (96.3–97.9)87.0 (83.5–90.5)99.1 (98.6–99.6)
    Depression81.1 (77.2–85.0)94.8 (93.7–95.9)79.6 (75.7–83.6)95.2 (94.1–96.3)
    COPD82.1 (76.0–88.2)97.3 (96.5–98.0)72.1 (65.4–78.8)98.4 (97.9–99.0)
    Osteoarthritis77.8 (74.5–81.1)94.9 (93.8–96.1)87.7 (84.9–90.5)90.2 (88.7–91.8)
    Dementia96.8 (93.3–100.0)98.1 (97.5–98.7)72.8 (65.0–80.6)99.8 (99.6–100.0)
    Epilepsy98.6 (96.6–100.0)98.7 (98.2–99.2)85.6 (80.2–91.1)99.9 (99.7–100.0)
    Parkinsonism98.8 (96.4–100.0)99.0 (98.6–99.5)82.0 (74.5–89.5)99.9 (99.8–100.0)
    • COPD = chronic obstructive pulmonary disease; NPV = negative predictive value; PPV = positive predictive value.

Additional Files

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    Supplemental Appendix. CPCSSN Case Definitions

    Files in this Data Supplement:

    • Supplemental data: Appendix - PDF file
  • In Brief

    Validating the 8 CPCSSN Case Definitions for Chronic Disease Surveillance in a Primary Care Database of Electronic Health Records

    Tyler Williamson , and colleagues

    Background Electronic medical records (EMRs) are a potential source of clinical data that can improve our understanding of the epidemiology of disease and effectiveness of disease prevention and management. Canada has established a national EMR data repository, but case definitions used to analyze the data must accurately reflect diagnoses within the EMR. This study develops and validates EMR-based case definitions and case finding algorithms used to identify eight common chronic conditions presenting in primary care.

    What This Study Found Valid diagnostic algorithms can be used to identify chronic conditions from electronic health record data for both research and public health purposes. Researchers reviewed 1,920 patient charts and validated algorithms for chronic obstructive pulmonary disease, dementia, depression, hypertension, osteoarthritis, parkinsonism, and epilepsy.

    Implications

    • These case definitions can be used for a variety of data-driven activities in primary care, including surveillance, routine practice evaluation, feedback, and quality improvement, and research.
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The Annals of Family Medicine: 12 (4)
The Annals of Family Medicine: 12 (4)
Vol. 12, Issue 4
July/August 2014
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Validating the 8 CPCSSN Case Definitions for Chronic Disease Surveillance in a Primary Care Database of Electronic Health Records
Tyler Williamson, Michael E. Green, Richard Birtwhistle, Shahriar Khan, Stephanie Garies, Sabrina T. Wong, Nandini Natarajan, Donna Manca, Neil Drummond
The Annals of Family Medicine Jul 2014, 12 (4) 367-372; DOI: 10.1370/afm.1644

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Validating the 8 CPCSSN Case Definitions for Chronic Disease Surveillance in a Primary Care Database of Electronic Health Records
Tyler Williamson, Michael E. Green, Richard Birtwhistle, Shahriar Khan, Stephanie Garies, Sabrina T. Wong, Nandini Natarajan, Donna Manca, Neil Drummond
The Annals of Family Medicine Jul 2014, 12 (4) 367-372; DOI: 10.1370/afm.1644
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