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Research article:

Optimising Use of Electronic Health Records to Describe the Presentation of Rheumatoid Arthritis in Primary Care: A Strategy for Developing Code Lists

Reference:

Amanda Nicholson, Elizabeth Ford, Kevin A. Davies, Helen E. Smith, Greta Rait, A. Rosemary Tate, Irene Petersen, Jackie Cassell(2013) Optimising Use of Electronic Health Records to Describe the Presentation of Rheumatoid Arthritis in Primary Care: A Strategy for Developing Code Lists. PLoS ONE, doi: 10.1371/journal.pone.0054878

Link to fulltext article
Abstract
Background Research using electronic health records (EHRs) relies heavily on coded clinical data. Due to variation in coding practices, it can be difficult to aggregate the codes for a condition in order to define cases. This paper describes a methodology to develop ‘indicator markers’ found in patients with early rheumatoid arthritis (RA); these are a broader range of codes which may allow a probabilistic case definition to use in cases where no diagnostic code is yet recorded. Methods We examined EHRs of 5,843 patients in the General Practice Research Database, aged ≥30y, with a first coded diagnosis of RA between 2005 and 2008. Lists of indicator markers for RA were developed initially by panels of clinicians drawing up code-lists and then modified based on scrutiny of available data. The prevalence of indicator markers, and their temporal relationship to RA codes, was examined in patients from 3y before to 14d after recorded RA diagnosis. Findings Indicator markers were common throughout EHRs of RA patients, with 83.5% having 2 or more markers. 34% of patients received a disease-specific prescription before RA was coded; 42% had a referral to rheumatology, and 63% had a test for rheumatoid factor. 65% had at least one joint symptom or sign recorded and in 44% this was at least 6-months before recorded RA diagnosis. Conclusion Indicator markers of RA may be valuable for case definition in cases which do not yet have a diagnostic code. The clinical diagnosis of RA is likely to occur some months before it is coded, shown by markers frequently occurring ≥6 months before recorded diagnosis. It is difficult to differentiate delay in diagnosis from delay in recording. Information concealed in free text may be required for the accurate identification of patients and to assess the quality of care in general practice.
Author for correspondence
Elizabeth Ford
Email for correspondence
e.m.ford@bsms.ac.uk

Code list: res13: Other Inflammatory Arthritis/conditions

35 codes in list

Code Coding system Description Entity type List name
L7873V Read ARTHRALGIA VIRAL diagnostic res13: Other Inflammatory Arthritis/conditions
M160.00 Read Psoriatic arthropathy diagnostic res13: Other Inflammatory Arthritis/conditions
M160000 Read Psoriasis spondylitica diagnostic res13: Other Inflammatory Arthritis/conditions
M160100 Read Distal interphalangeal psoriatic arthropathy diagnostic res13: Other Inflammatory Arthritis/conditions
M160.11 Read diagnostic res13: Other Inflammatory Arthritis/conditions
M160200 Read Arthritis mutilans diagnostic res13: Other Inflammatory Arthritis/conditions
M160z00 Read Psoriatic arthropathy NOS diagnostic res13: Other Inflammatory Arthritis/conditions
N044.00 Read Chronic post-rheumatic arthropathy diagnostic res13: Other Inflammatory Arthritis/conditions
N044.11 Read Jaccoud's syndrome diagnostic res13: Other Inflammatory Arthritis/conditions
N044.12 Read Nodular fibrositis of chronic rheumatic disease diagnostic res13: Other Inflammatory Arthritis/conditions
N045200 Read Juvenile arthritis in psoriasis diagnostic res13: Other Inflammatory Arthritis/conditions
N045300 Read Juvenile arthritis in Crohn's disease diagnostic res13: Other Inflammatory Arthritis/conditions
N045400 Read Juvenile arthritis in ulcerative colitis diagnostic res13: Other Inflammatory Arthritis/conditions
N067.00 Read Ochronotic arthropathy diagnostic res13: Other Inflammatory Arthritis/conditions
N06y900 Read Other specified arthropathy of multiple sites diagnostic res13: Other Inflammatory Arthritis/conditions
N20..00 Read Polymyalgia rheumatica diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu0.00 Read [X]Infectious arthropathies diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu0000 Read [X]Other streptococcal arthritis and polyarthritis diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu0100 Read [X]Arthritis+polyarthritis due/other specfd bacterial agents diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu0200 Read [X]Arthritis in other infectious and parasitic diseases CE diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu0300 Read [X]Other reactive arthropathies diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu0400 Read [X]Other postinfectious arthropathies in diseases CE diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu0500 Read [X]Reactive arthropathy in other diseases CE diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu1300 Read [X]Other psoriatic arthropathies diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu1400 Read [X]Other enteropathic arthropathies diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu1600 Read [X]Juvenile arthritis in other diseases CE diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu1700 Read [X]Other secondary gout diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu1900 Read [X]Other specified crystal arthropathies diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu1C00 Read [X]Gouty arthrpathy due/enzym defects+oth inherit disordr CE diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu1D00 Read [X]Crystal arthropathy in other metabolic disorders CE diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu1E00 Read [X]Arthropathies/oth endocrin;nutritionl+metabolic disorders diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu2B00 Read [X]Other 2ndry arthrosis/1st carpometacarpal joints;bilaterl diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu2D00 Read [X]Other specified arthrosis diagnostic res13: Other Inflammatory Arthritis/conditions
Nyu4B00 Read [X]Arthropathy in hypersensitivity reactions CE diagnostic res13: Other Inflammatory Arthritis/conditions
7149A OXMIS RHEUMATIC ARTHRITIS diagnostic res13: Other Inflammatory Arthritis/conditions

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