Optimising case detection within UK electronic health records: use of multiple linked databases for detecting liver injury

Kevin Wing; Krishnan Bhaskaran; Liam Smeeth; Tjeerd P van Staa; Olaf H Klungel; Robert F Reynolds; Ian Douglas

doi:10.1136/bmjopen-2016-012102

Optimising case detection within UK electronic health records: use of multiple linked databases for detecting liver injury

Kevin Wing, Krishnan Bhaskaran, Liam Smeeth, Tjeerd P van Staa, Olaf H Klungel, Robert F Reynolds, Ian Douglas

Pharmacoepidemiology and Clinical Pharmacology

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

OBJECTIVES: We aimed to create a 'multidatabase' algorithm for identification of cholestatic liver injury using multiple linked UK databases, before (1) assessing the improvement in case ascertainment compared to using a single database and (2) developing a new single-database case-definition algorithm, validated against the multidatabase algorithm.

DESIGN: Method development for case ascertainment.

SETTING: Three UK population-based electronic health record databases: the UK Clinical Practice Research Datalink (CPRD), the UK Hospital Episodes Statistics (HES) database and the UK Office of National Statistics (ONS) mortality database.

PARTICIPANTS: 16 040 people over the age of 18 years with linked CPRD-HES records indicating potential cholestatic liver injury between 1 January 2000 and 1 January 2013.

PRIMARY OUTCOME MEASURES: (1) The number of cases of cholestatic liver injury detected by the multidatabase algorithm. (2) The relative contribution of each data source to multidatabase case status. (3) The ability of the new single-database algorithm to discriminate multidatabase algorithm case status.

RESULTS: Within the multidatabase case identification algorithm, 4033 of 16 040 potential cases (25%) were identified as definite cases based on CPRD data. HES data allowed possible cases to be discriminated from unlikely cases (947 of 16 040, 6%), but only facilitated identification of 1 definite case. ONS data did not contribute to case definition. The new single-database (CPRD-only) algorithm had a very good ability to discriminate multidatabase case status (area under the receiver operator characteristic curve 0.95).

CONCLUSIONS: CPRD-HES-ONS linkage confers minimal improvement in cholestatic liver injury case ascertainment compared to using CPRD data alone, and a multidatabase algorithm provides little additional information for validation of a CPRD-only algorithm. The availability of laboratory test results within CPRD but not HES means that algorithms based on CPRD-HES-linked data may not always be merited for studies of liver injury, or for other outcomes relying primarily on laboratory test results.

Original language	English
Article number	e012102
Pages (from-to)	1-12
Number of pages	12
Journal	BMJ Open
Volume	6
Issue number	9
DOIs	https://doi.org/10.1136/bmjopen-2016-012102
Publication status	Published - 2016

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@article{bda4e56d220c4602826e173252181848,

title = "Optimising case detection within UK electronic health records: use of multiple linked databases for detecting liver injury",

abstract = "OBJECTIVES: We aimed to create a 'multidatabase' algorithm for identification of cholestatic liver injury using multiple linked UK databases, before (1) assessing the improvement in case ascertainment compared to using a single database and (2) developing a new single-database case-definition algorithm, validated against the multidatabase algorithm.DESIGN: Method development for case ascertainment.SETTING: Three UK population-based electronic health record databases: the UK Clinical Practice Research Datalink (CPRD), the UK Hospital Episodes Statistics (HES) database and the UK Office of National Statistics (ONS) mortality database.PARTICIPANTS: 16 040 people over the age of 18 years with linked CPRD-HES records indicating potential cholestatic liver injury between 1 January 2000 and 1 January 2013.PRIMARY OUTCOME MEASURES: (1) The number of cases of cholestatic liver injury detected by the multidatabase algorithm. (2) The relative contribution of each data source to multidatabase case status. (3) The ability of the new single-database algorithm to discriminate multidatabase algorithm case status.RESULTS: Within the multidatabase case identification algorithm, 4033 of 16 040 potential cases (25%) were identified as definite cases based on CPRD data. HES data allowed possible cases to be discriminated from unlikely cases (947 of 16 040, 6%), but only facilitated identification of 1 definite case. ONS data did not contribute to case definition. The new single-database (CPRD-only) algorithm had a very good ability to discriminate multidatabase case status (area under the receiver operator characteristic curve 0.95).CONCLUSIONS: CPRD-HES-ONS linkage confers minimal improvement in cholestatic liver injury case ascertainment compared to using CPRD data alone, and a multidatabase algorithm provides little additional information for validation of a CPRD-only algorithm. The availability of laboratory test results within CPRD but not HES means that algorithms based on CPRD-HES-linked data may not always be merited for studies of liver injury, or for other outcomes relying primarily on laboratory test results.",

author = "Kevin Wing and Krishnan Bhaskaran and Liam Smeeth and {van Staa}, {Tjeerd P} and Klungel, {Olaf H} and Reynolds, {Robert F} and Ian Douglas",

note = "Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/",

year = "2016",

doi = "10.1136/bmjopen-2016-012102",

language = "English",

volume = "6",

pages = "1--12",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group Ltd",

number = "9",

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TY - JOUR

T1 - Optimising case detection within UK electronic health records

T2 - use of multiple linked databases for detecting liver injury

AU - Wing, Kevin

AU - Bhaskaran, Krishnan

AU - Smeeth, Liam

AU - van Staa, Tjeerd P

AU - Klungel, Olaf H

AU - Reynolds, Robert F

AU - Douglas, Ian

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

PY - 2016

Y1 - 2016

N2 - OBJECTIVES: We aimed to create a 'multidatabase' algorithm for identification of cholestatic liver injury using multiple linked UK databases, before (1) assessing the improvement in case ascertainment compared to using a single database and (2) developing a new single-database case-definition algorithm, validated against the multidatabase algorithm.DESIGN: Method development for case ascertainment.SETTING: Three UK population-based electronic health record databases: the UK Clinical Practice Research Datalink (CPRD), the UK Hospital Episodes Statistics (HES) database and the UK Office of National Statistics (ONS) mortality database.PARTICIPANTS: 16 040 people over the age of 18 years with linked CPRD-HES records indicating potential cholestatic liver injury between 1 January 2000 and 1 January 2013.PRIMARY OUTCOME MEASURES: (1) The number of cases of cholestatic liver injury detected by the multidatabase algorithm. (2) The relative contribution of each data source to multidatabase case status. (3) The ability of the new single-database algorithm to discriminate multidatabase algorithm case status.RESULTS: Within the multidatabase case identification algorithm, 4033 of 16 040 potential cases (25%) were identified as definite cases based on CPRD data. HES data allowed possible cases to be discriminated from unlikely cases (947 of 16 040, 6%), but only facilitated identification of 1 definite case. ONS data did not contribute to case definition. The new single-database (CPRD-only) algorithm had a very good ability to discriminate multidatabase case status (area under the receiver operator characteristic curve 0.95).CONCLUSIONS: CPRD-HES-ONS linkage confers minimal improvement in cholestatic liver injury case ascertainment compared to using CPRD data alone, and a multidatabase algorithm provides little additional information for validation of a CPRD-only algorithm. The availability of laboratory test results within CPRD but not HES means that algorithms based on CPRD-HES-linked data may not always be merited for studies of liver injury, or for other outcomes relying primarily on laboratory test results.

AB - OBJECTIVES: We aimed to create a 'multidatabase' algorithm for identification of cholestatic liver injury using multiple linked UK databases, before (1) assessing the improvement in case ascertainment compared to using a single database and (2) developing a new single-database case-definition algorithm, validated against the multidatabase algorithm.DESIGN: Method development for case ascertainment.SETTING: Three UK population-based electronic health record databases: the UK Clinical Practice Research Datalink (CPRD), the UK Hospital Episodes Statistics (HES) database and the UK Office of National Statistics (ONS) mortality database.PARTICIPANTS: 16 040 people over the age of 18 years with linked CPRD-HES records indicating potential cholestatic liver injury between 1 January 2000 and 1 January 2013.PRIMARY OUTCOME MEASURES: (1) The number of cases of cholestatic liver injury detected by the multidatabase algorithm. (2) The relative contribution of each data source to multidatabase case status. (3) The ability of the new single-database algorithm to discriminate multidatabase algorithm case status.RESULTS: Within the multidatabase case identification algorithm, 4033 of 16 040 potential cases (25%) were identified as definite cases based on CPRD data. HES data allowed possible cases to be discriminated from unlikely cases (947 of 16 040, 6%), but only facilitated identification of 1 definite case. ONS data did not contribute to case definition. The new single-database (CPRD-only) algorithm had a very good ability to discriminate multidatabase case status (area under the receiver operator characteristic curve 0.95).CONCLUSIONS: CPRD-HES-ONS linkage confers minimal improvement in cholestatic liver injury case ascertainment compared to using CPRD data alone, and a multidatabase algorithm provides little additional information for validation of a CPRD-only algorithm. The availability of laboratory test results within CPRD but not HES means that algorithms based on CPRD-HES-linked data may not always be merited for studies of liver injury, or for other outcomes relying primarily on laboratory test results.

U2 - 10.1136/bmjopen-2016-012102

DO - 10.1136/bmjopen-2016-012102

M3 - Article

C2 - 27591023

SN - 2044-6055

VL - 6

SP - 1

EP - 12

JO - BMJ Open

JF - BMJ Open

IS - 9

M1 - e012102

ER -

Optimising case detection within UK electronic health records: use of multiple linked databases for detecting liver injury

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