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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: Rheumatoid Arthritis
61 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 2G25.00 | Read | O/E - hands - ulnar deviation | diagnostic | res13: Rheumatoid Arthritis | |||
| 2G25.11 | Read | O/E - ulnar deviation | diagnostic | res13: Rheumatoid Arthritis | |||
| 2G27.00 | Read | O/E-hands-rheumatoid spindling | diagnostic | res13: Rheumatoid Arthritis | |||
| 66H..13 | Read | Rheumatoid arthrit. monitoring | diagnostic | res13: Rheumatoid Arthritis | |||
| F371200 | Read | Polyneuropathy in rheumatoid arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| F396400 | Read | Myopathy due to rheumatoid arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| G5y8.00 | Read | Rheumatoid myocarditis | diagnostic | res13: Rheumatoid Arthritis | |||
| G5yA.00 | Read | Rheumatoid carditis | diagnostic | res13: Rheumatoid Arthritis | |||
| H570.00 | Read | Rheumatoid lung | diagnostic | res13: Rheumatoid Arthritis | |||
| N005.00 | Read | Adult Still's Disease | diagnostic | res13: Rheumatoid Arthritis | |||
| N04..00 | Read | Rheumatoid arthritis and other inflammatory polyarthropathy | diagnostic | res13: Rheumatoid Arthritis | |||
| N040.00 | Read | Rheumatoid arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| N040000 | Read | Rheumatoid arthritis of cervical spine | diagnostic | res13: Rheumatoid Arthritis | |||
| N040100 | Read | Other rheumatoid arthritis of spine | diagnostic | res13: Rheumatoid Arthritis | |||
| N040200 | Read | Rheumatoid arthritis of shoulder | diagnostic | res13: Rheumatoid Arthritis | |||
| N040500 | Read | Rheumatoid arthritis of elbow | diagnostic | res13: Rheumatoid Arthritis | |||
| N040600 | Read | Rheumatoid arthritis of distal radio-ulnar joint | diagnostic | res13: Rheumatoid Arthritis | |||
| N040700 | Read | Rheumatoid arthritis of wrist | diagnostic | res13: Rheumatoid Arthritis | |||
| N040800 | Read | Rheumatoid arthritis of MCP joint | diagnostic | res13: Rheumatoid Arthritis | |||
| N040900 | Read | Rheumatoid arthritis of PIP joint of finger | diagnostic | res13: Rheumatoid Arthritis | |||
| N040A00 | Read | Rheumatoid arthritis of DIP joint of finger | diagnostic | res13: Rheumatoid Arthritis | |||
| N040B00 | Read | Rheumatoid arthritis of hip | diagnostic | res13: Rheumatoid Arthritis | |||
| N040D00 | Read | Rheumatoid arthritis of knee | diagnostic | res13: Rheumatoid Arthritis | |||
| N040F00 | Read | Rheumatoid arthritis of ankle | diagnostic | res13: Rheumatoid Arthritis | |||
| N040G00 | Read | Rheumatoid arthritis of subtalar joint | diagnostic | res13: Rheumatoid Arthritis | |||
| N040H00 | Read | Rheumatoid arthritis of talonavicular joint | diagnostic | res13: Rheumatoid Arthritis | |||
| N040J00 | Read | Rheumatoid arthritis of other tarsal joint | diagnostic | res13: Rheumatoid Arthritis | |||
| N040K00 | Read | Rheumatoid arthritis of 1st MTP joint | diagnostic | res13: Rheumatoid Arthritis | |||
| N040N00 | Read | Rheumatoid vasculitis | diagnostic | res13: Rheumatoid Arthritis | |||
| N040P00 | Read | Seronegative rheumatoid arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| N040Q00 | Read | Rheumatoid bursitis | diagnostic | res13: Rheumatoid Arthritis | |||
| N040R00 | Read | Rheumatoid nodule | diagnostic | res13: Rheumatoid Arthritis | |||
| N040S00 | Read | Rheumatoid arthritis - multiple joint | diagnostic | res13: Rheumatoid Arthritis | |||
| N040T00 | Read | Flare of rheumatoid arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| N041.00 | Read | Felty's syndrome | diagnostic | res13: Rheumatoid Arthritis | |||
| N042.00 | Read | Other rheumatoid arthropathy + visceral/systemic involvement | diagnostic | res13: Rheumatoid Arthritis | |||
| N042100 | Read | Rheumatoid lung disease | diagnostic | res13: Rheumatoid Arthritis | |||
| N042200 | Read | Rheumatoid nodule | diagnostic | res13: Rheumatoid Arthritis | |||
| N042z00 | Read | Rheumatoid arthropathy + visceral/systemic involvement NOS | diagnostic | res13: Rheumatoid Arthritis | |||
| N043.00 | Read | Juvenile rheumatoid arthritis - Still's disease | diagnostic | res13: Rheumatoid Arthritis | |||
| N043000 | Read | Juvenile rheumatoid arthropathy unspecified | diagnostic | res13: Rheumatoid Arthritis | |||
| N043100 | Read | Acute polyarticular juvenile rheumatoid arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| N043200 | Read | Pauciarticular juvenile rheumatoid arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| N043300 | Read | Monarticular juvenile rheumatoid arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| N043z00 | Read | Juvenile rheumatoid arthritis NOS | diagnostic | res13: Rheumatoid Arthritis | |||
| N045.00 | Read | Other juvenile arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| N045000 | Read | Juvenile ankylosing spondylitis | diagnostic | res13: Rheumatoid Arthritis | |||
| N045100 | Read | Juvenile seronegative polyarthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| N045500 | Read | Juvenile rheumatoid arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| N045600 | Read | Pauciarticular onset juvenile chronic arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| N047.00 | Read | Seropositive errosive rheumatoid arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| N04X.00 | Read | Seropositive rheumatoid arthritis; unspecified | diagnostic | res13: Rheumatoid Arthritis | |||
| N04y000 | Read | Rheumatoid lung | diagnostic | res13: Rheumatoid Arthritis | |||
| N04y011 | Read | Caplan's syndrome | diagnostic | res13: Rheumatoid Arthritis | |||
| N04y012 | Read | Fibrosing alveolitis associated with rheumatoid arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| N04y200 | Read | Adult-onset Still's disease | diagnostic | res13: Rheumatoid Arthritis | |||
| N362200 | Read | Swan-neck finger deformity | diagnostic | res13: Rheumatoid Arthritis | |||
| Nyu1100 | Read | [X]Other seropositive rheumatoid arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| Nyu1200 | Read | [X]Other specified rheumatoid arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| Nyu1500 | Read | [X]Other juvenile arthritis | diagnostic | res13: Rheumatoid Arthritis | |||
| Nyu1G00 | Read | [X]Seropositive rheumatoid arthritis; unspecified | diagnostic | res13: Rheumatoid Arthritis |
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