PS1-19: Method for Using the Electronic Health Record to Create Population Denominators
Background/Aims: The HMORN includes research centers that are part of integrated delivery systems where the practice and insurance entities are independent. Rules for defining a population denominator at these centers require a consideration of the practice population that is not a member of the ins...
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Veröffentlicht in: | Clinical medicine & research 2010-03, Vol.8 (1), p.61-61 |
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Sprache: | eng |
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Zusammenfassung: | Background/Aims:
The HMORN includes research centers that are part of integrated delivery systems where the practice and insurance entities are independent. Rules for defining a population denominator at these centers require a consideration of the practice population that is not a member of the insurance entity, as the notion of enrollment and disenrollment is not relevant. We describe methods for defining a population denominator for primary care patients using data from only the electronic health record (EHR), including consideration criteria for dates that are analogous to membership enrollment and disenrollment. The aim of this study was to create a method for calculating population denominators from the EHR based on utilization activity.
Methods:
We modeled data on the pattern of utilization over time to determine start and termination dates for time under observation. Survival analysis was used to estimate the probability of cohort with drawl after various lengths of utilization inactivity. Optimal cutoffs were derived that balanced false positives with false negatives. Since the length of time required for a patient to become inactive is likely dependent upon age and gender (i.e. a typical gap in utilization will tend to be longer for young males as compared to older males), the cutoffs for defining termination dates varied based on patient demographic.
Results:
For each unique patient, the number of encounters were counted for each 6-month time period (i.e. January 1 – June 31, and July 1 – December 31). To define cohort entry, the 6-month period in which the first office visit encounter occurred was used to define a starting date. Enrollment was considered active until the patient failed to have any encounters with a primary care clinic for an age/gender specific cutoff of number of consecutive 6-month periods, at which point the end date will be retroactively assigned to the end of the 6-month period in which the final encounter occurred.
Conclusions:
EHR utilization can be used to define population denominators. Validation of the proposed method needs to be conducted by comparing results to insurance enrollment spans. This application is limited to clinical areas where there is evidence of relatively complete capture. |
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ISSN: | 1539-4182 1554-6179 |
DOI: | 10.3121/cmr.8.1.61-b |