Mind the gap: observation windows to define periods of event ascertainment as a quality control method for longitudinal electronic health record data

North American AIDS Cohort Collaboration on Research and Design

Research output: Contribution to journalArticle

Abstract

Purpose: Use of electronic health records (EHRs) in health research may lead to the false assumption of complete event ascertainment. We estimated “observation windows” (OWs), defined as periods within which the assumption of complete ascertainment of events is more likely to hold, as a quality control approach to reducing the likelihood of this false assumption. We demonstrated the impact of OWs on estimating the rates of type II diabetes mellitus (diabetes) from HIV clinical cohorts. Methods: Data contributed by 16 HIV clinical cohorts to the NA-ACCORD were used to identify and evaluate OWs for an operationalized definition of diabetes occurrence as a case study. Procedures included (1) gathering cohort-level data; (2) visualizing and summarizing gaps in observations; (3) systematically establishing start and stop dates during which the assumption of complete ascertainment of diabetes events was reasonable; and (4) visualizing the diabetes OWs relative to the cohort open and close dates to identify immortal person-time. We estimated diabetes occurrence event rates and 95% confidence intervals in the most recent decade that data were available (January 1, 2007, to December 31, 2016). Results: The number of diabetes events decreased by 17% with the use of the diabetes OWs; immortal person-time was removed decreasing total person-years by 23%. Consequently, the diabetes rate increased from 1.23 (95% confidence interval [1.20, 1.25]) per 100 person-years to 1.32 [1.29, 1.35] per 100 person-years with the use of diabetes OWs. Conclusions: As the use of EHR-curated data for event-driven health research continues to expand, OWs have utility as a quality control approach to complete event ascertainment, helping to improve accuracy of estimates by removing immortal person-time when ascertainment is incomplete.

Original languageEnglish (US)
JournalAnnals of epidemiology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Electronic Health Records
Quality Control
Observation
HIV
Confidence Intervals
Health
Research
Type 2 Diabetes Mellitus

Keywords

  • Diabetes
  • Electronic medical records
  • Health research
  • HIV
  • Immortal person-time
  • Quality control

ASJC Scopus subject areas

  • Epidemiology

Cite this

Mind the gap : observation windows to define periods of event ascertainment as a quality control method for longitudinal electronic health record data. / North American AIDS Cohort Collaboration on Research and Design.

In: Annals of epidemiology, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Mind the gap: observation windows to define periods of event ascertainment as a quality control method for longitudinal electronic health record data",
abstract = "Purpose: Use of electronic health records (EHRs) in health research may lead to the false assumption of complete event ascertainment. We estimated “observation windows” (OWs), defined as periods within which the assumption of complete ascertainment of events is more likely to hold, as a quality control approach to reducing the likelihood of this false assumption. We demonstrated the impact of OWs on estimating the rates of type II diabetes mellitus (diabetes) from HIV clinical cohorts. Methods: Data contributed by 16 HIV clinical cohorts to the NA-ACCORD were used to identify and evaluate OWs for an operationalized definition of diabetes occurrence as a case study. Procedures included (1) gathering cohort-level data; (2) visualizing and summarizing gaps in observations; (3) systematically establishing start and stop dates during which the assumption of complete ascertainment of diabetes events was reasonable; and (4) visualizing the diabetes OWs relative to the cohort open and close dates to identify immortal person-time. We estimated diabetes occurrence event rates and 95{\%} confidence intervals in the most recent decade that data were available (January 1, 2007, to December 31, 2016). Results: The number of diabetes events decreased by 17{\%} with the use of the diabetes OWs; immortal person-time was removed decreasing total person-years by 23{\%}. Consequently, the diabetes rate increased from 1.23 (95{\%} confidence interval [1.20, 1.25]) per 100 person-years to 1.32 [1.29, 1.35] per 100 person-years with the use of diabetes OWs. Conclusions: As the use of EHR-curated data for event-driven health research continues to expand, OWs have utility as a quality control approach to complete event ascertainment, helping to improve accuracy of estimates by removing immortal person-time when ascertainment is incomplete.",
keywords = "Diabetes, Electronic medical records, Health research, HIV, Immortal person-time, Quality control",
author = "{North American AIDS Cohort Collaboration on Research and Design} and Keri Althoff and Cherise Wong and Brenna Hogan and Fidel Desir and Bin You and Elizabeth Humes and Jinbing Zhang and Yuezhou Jing and Modur, {Sharada P} and Jennifer Lee and Aimee Freeman and Mari Kitahata and {Van Rompaey}, Stephen and Mathews, {W. Christopher} and Horberg, {Michael A.} and Silverberg, {Michael J.} and Mayor, {Angel M.} and Kate Salters and Moore, {Richard D} and Gange, {Stephen J}",
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AU - North American AIDS Cohort Collaboration on Research and Design

AU - Althoff, Keri

AU - Wong, Cherise

AU - Hogan, Brenna

AU - Desir, Fidel

AU - You, Bin

AU - Humes, Elizabeth

AU - Zhang, Jinbing

AU - Jing, Yuezhou

AU - Modur, Sharada P

AU - Lee, Jennifer

AU - Freeman, Aimee

AU - Kitahata, Mari

AU - Van Rompaey, Stephen

AU - Mathews, W. Christopher

AU - Horberg, Michael A.

AU - Silverberg, Michael J.

AU - Mayor, Angel M.

AU - Salters, Kate

AU - Moore, Richard D

AU - Gange, Stephen J

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N2 - Purpose: Use of electronic health records (EHRs) in health research may lead to the false assumption of complete event ascertainment. We estimated “observation windows” (OWs), defined as periods within which the assumption of complete ascertainment of events is more likely to hold, as a quality control approach to reducing the likelihood of this false assumption. We demonstrated the impact of OWs on estimating the rates of type II diabetes mellitus (diabetes) from HIV clinical cohorts. Methods: Data contributed by 16 HIV clinical cohorts to the NA-ACCORD were used to identify and evaluate OWs for an operationalized definition of diabetes occurrence as a case study. Procedures included (1) gathering cohort-level data; (2) visualizing and summarizing gaps in observations; (3) systematically establishing start and stop dates during which the assumption of complete ascertainment of diabetes events was reasonable; and (4) visualizing the diabetes OWs relative to the cohort open and close dates to identify immortal person-time. We estimated diabetes occurrence event rates and 95% confidence intervals in the most recent decade that data were available (January 1, 2007, to December 31, 2016). Results: The number of diabetes events decreased by 17% with the use of the diabetes OWs; immortal person-time was removed decreasing total person-years by 23%. Consequently, the diabetes rate increased from 1.23 (95% confidence interval [1.20, 1.25]) per 100 person-years to 1.32 [1.29, 1.35] per 100 person-years with the use of diabetes OWs. Conclusions: As the use of EHR-curated data for event-driven health research continues to expand, OWs have utility as a quality control approach to complete event ascertainment, helping to improve accuracy of estimates by removing immortal person-time when ascertainment is incomplete.

AB - Purpose: Use of electronic health records (EHRs) in health research may lead to the false assumption of complete event ascertainment. We estimated “observation windows” (OWs), defined as periods within which the assumption of complete ascertainment of events is more likely to hold, as a quality control approach to reducing the likelihood of this false assumption. We demonstrated the impact of OWs on estimating the rates of type II diabetes mellitus (diabetes) from HIV clinical cohorts. Methods: Data contributed by 16 HIV clinical cohorts to the NA-ACCORD were used to identify and evaluate OWs for an operationalized definition of diabetes occurrence as a case study. Procedures included (1) gathering cohort-level data; (2) visualizing and summarizing gaps in observations; (3) systematically establishing start and stop dates during which the assumption of complete ascertainment of diabetes events was reasonable; and (4) visualizing the diabetes OWs relative to the cohort open and close dates to identify immortal person-time. We estimated diabetes occurrence event rates and 95% confidence intervals in the most recent decade that data were available (January 1, 2007, to December 31, 2016). Results: The number of diabetes events decreased by 17% with the use of the diabetes OWs; immortal person-time was removed decreasing total person-years by 23%. Consequently, the diabetes rate increased from 1.23 (95% confidence interval [1.20, 1.25]) per 100 person-years to 1.32 [1.29, 1.35] per 100 person-years with the use of diabetes OWs. Conclusions: As the use of EHR-curated data for event-driven health research continues to expand, OWs have utility as a quality control approach to complete event ascertainment, helping to improve accuracy of estimates by removing immortal person-time when ascertainment is incomplete.

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KW - Health research

KW - HIV

KW - Immortal person-time

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