Article Figures & Data
Figures
- 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.
Tables
Case Definition Condition Inclusions Exclusions Diabetes Diabetes mellitus type 1 and type 2, controlled or uncontrolled Gestational 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) Hypertension Essential hypertension, hypertensive heart disease, hypertensive chronic kidney disease, hypertensive heart and kidney disease, secondary hypertensiona Myocardial 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 COPD Obstructive chronic bronchitis, emphysema, chronic airway obstruction (ever)b All types of asthma, including chronic obstructive asthma Depression Episodic mood disorders, depressive disorder not elsewhere classified, bipolar, manic affective disorder, manic episodes, mild depression (not simply clinical depression)c Anxiety disorders, alcohol or drug-induced mental disorders, schizophrenic disorders, delusional disorders, other nonorganic psychoses, pervasive developmental disorders, or other intellectual disabilities Osteoarthritis Osteoarthritis and allied disorders, spondylosis and allied disorders such as kissing spine, ankylosing vertebral hyperostosis Intervertebral disc disorders, spinal stenosis, ankylosing spondylitis, and other inflammatory spondylopathies Epilepsy Epilepsy, recurrent seizures or general convulsions, petit mal (absence) seizures, grand mal (tonic-clonic) seizures, myoclonic epilepsy, childhood-onset epilepsy, childhood-related epilepsy Provoked seizure, alcohol withdrawal seizure, hypoglycemic seizure, or possible or suspected variants of the inclusionsd Parkinsonism Parkinson disease, paralysis agitans, parkinsonism Tremor, Wolf-Parkinson-White syndrome, and “suspected” or “possible” variants of the inclusions Dementia Alzheimer 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.
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↵a Requires an explicit diagnosis of hypertension (eg, elevated blood pressure values alone are insufficient).
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↵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.
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↵c This definition identifies lifetime prevalence.
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↵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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Patient Characteristics Percent Male 44.5 Age ≥60 y 85.4 Disease prevalence Diabetes 16.8 Hypertension 50.1 Depression 20.2 COPD 7.9 Osteoarthritis 31.6 Dementia 4.9 Epilepsy 7.3 Parkinsonism 4.3 Number of chronic conditions (of 8 CPCSSN conditions) 0 22.7 1 34.6 2 26.1 3 or more 16.6 -
COPD = chronic obstructive pulmonary disease; CPCSSN = Canadian Primary Care Sentinel Surveillance Network.
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Condition Sensitivity % (95% CI) Specificity % (95% CI) PPV % (95% CI) NPV % (95% CI) Hypertension 84.9 (82.6–87.1) 93.5 (92.0–95.1) 92.9 (91.2–94.6) 86.0 (83.9–88.2) Diabetes 95.6 (93.4–97.9) 97.1 (96.3–97.9) 87.0 (83.5–90.5) 99.1 (98.6–99.6) Depression 81.1 (77.2–85.0) 94.8 (93.7–95.9) 79.6 (75.7–83.6) 95.2 (94.1–96.3) COPD 82.1 (76.0–88.2) 97.3 (96.5–98.0) 72.1 (65.4–78.8) 98.4 (97.9–99.0) Osteoarthritis 77.8 (74.5–81.1) 94.9 (93.8–96.1) 87.7 (84.9–90.5) 90.2 (88.7–91.8) Dementia 96.8 (93.3–100.0) 98.1 (97.5–98.7) 72.8 (65.0–80.6) 99.8 (99.6–100.0) Epilepsy 98.6 (96.6–100.0) 98.7 (98.2–99.2) 85.6 (80.2–91.1) 99.9 (99.7–100.0) Parkinsonism 98.8 (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.
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Supplemental Appendix
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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