An approach to linking education, social care and electronic health records for children and young people in South London: a linkage study of child and adolescent mental health service data
ObjectivesCreation of linked mental health, social and education records for research to support evidence-based practice for regional mental health services.SettingThe Clinical Record Interactive Search (CRIS) system was used to extract personal identifiers who accessed psychiatric services between...
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| Veröffentlicht in: | BMJ open 2019-01, Vol.9 (1), p.e024355-e024355 |
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| creator | Downs, Johnny M Ford, Tamsin Stewart, Robert Epstein, Sophie Shetty, Hitesh Little, Ryan Jewell, Amelia Broadbent, Matthew Deighton, Jessica Mostafa, Tarek Gilbert, Ruth Hotopf, Matthew Hayes, Richard |
| description | ObjectivesCreation of linked mental health, social and education records for research to support evidence-based practice for regional mental health services.SettingThe Clinical Record Interactive Search (CRIS) system was used to extract personal identifiers who accessed psychiatric services between September 2007 and August 2013.ParticipantsA clinical cohort of 35 509 children and young people (aged 4–17 years).DesignMultiple government and ethical committees approved the link of clinical mental health service data to Department for Education (DfE) data on education and social care services. Under robust governance protocols, fuzzy and deterministic approaches were used by the DfE to match personal identifiers (names, date of birth and postcode) from National Pupil Database (NPD) and CRIS data sources.Outcome measuresRisk factors for non-matching to NPD were identified, and the potential impact of non-match biases on International Statistical Classification of Diseases, 10th Revision (ICD-10) classifications of mental disorder, and persistent school absence ( |
| doi_str_mv | 10.1136/bmjopen-2018-024355 |
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Under robust governance protocols, fuzzy and deterministic approaches were used by the DfE to match personal identifiers (names, date of birth and postcode) from National Pupil Database (NPD) and CRIS data sources.Outcome measuresRisk factors for non-matching to NPD were identified, and the potential impact of non-match biases on International Statistical Classification of Diseases, 10th Revision (ICD-10) classifications of mental disorder, and persistent school absence (<80% attendance) were examined. Probability weighting and adjustment methods were explored as methods to mitigate the impact of non-match biases.Results Governance challenges included developing a research protocol for data linkage, which met the legislative requirements for both National Health Service and DfE. From CRIS, 29 278 (82.5%) were matched to NPD school attendance records. Presenting to services in late adolescence (adjusted OR (aOR) 0.67, 95% CI 0.59 to 0.75) or outside of school census timeframes (aOR 0.15, 95% CI 0.14 to 0.17) reduced likelihood of matching. After adjustments for linkage error, ICD-10 mental disorder remained significantly associated with persistent school absence (aOR 1.13, 95% CI 1.07 to 1.22).ConclusionsThe work described sets a precedent for education data being used for medical benefit in England. Linkage between health and education records offers a powerful tool for evaluating the impact of mental health on school function, but biases due to linkage error may produce misleading results. Collaborative research with data providers is needed to develop linkage methods that minimise potential biases in analyses of linked data.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2018-024355</identifier><identifier>PMID: 30700480</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adolescent ; Autism ; Bias ; Child ; Child & adolescent mental health ; Child, Preschool ; Children & youth ; Childrens health ; Classification ; Confidentiality ; Databases, Factual ; Education ; Educational services ; Electronic Health Records ; Epidemiology ; Evidence-Based Practice ; Female ; General Data Protection Regulation ; Health services ; Humans ; Information Storage and Retrieval - methods ; Linked Data ; London ; Longitudinal studies ; Male ; Medical Informatics ; Medical research ; Mental Health ; Mental health care ; Mental Health Services ; Psychiatry ; Psychosis ; Psychotropic drugs ; Public health ; Public services ; Records ; Schools ; Social Work ; State Medicine ; Teenagers</subject><ispartof>BMJ open, 2019-01, Vol.9 (1), p.e024355-e024355</ispartof><rights>Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.</rights><rights>2019 Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b472t-acec7d3d9333562e9a2fd9b0b6218f2f8abcd8a7be56605960ff246ffc5d43c93</citedby><cites>FETCH-LOGICAL-b472t-acec7d3d9333562e9a2fd9b0b6218f2f8abcd8a7be56605960ff246ffc5d43c93</cites><orcidid>0000-0002-2118-908X ; 0000-0002-8061-295X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://bmjopen.bmj.com/content/9/1/e024355.full.pdf$$EPDF$$P50$$Gbmj$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://bmjopen.bmj.com/content/9/1/e024355.full$$EHTML$$P50$$Gbmj$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27528,27529,27903,27904,53769,53771,77347,77378</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30700480$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Downs, Johnny M</creatorcontrib><creatorcontrib>Ford, Tamsin</creatorcontrib><creatorcontrib>Stewart, Robert</creatorcontrib><creatorcontrib>Epstein, Sophie</creatorcontrib><creatorcontrib>Shetty, Hitesh</creatorcontrib><creatorcontrib>Little, Ryan</creatorcontrib><creatorcontrib>Jewell, Amelia</creatorcontrib><creatorcontrib>Broadbent, Matthew</creatorcontrib><creatorcontrib>Deighton, Jessica</creatorcontrib><creatorcontrib>Mostafa, Tarek</creatorcontrib><creatorcontrib>Gilbert, Ruth</creatorcontrib><creatorcontrib>Hotopf, Matthew</creatorcontrib><creatorcontrib>Hayes, Richard</creatorcontrib><title>An approach to linking education, social care and electronic health records for children and young people in South London: a linkage study of child and adolescent mental health service data</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>ObjectivesCreation of linked mental health, social and education records for research to support evidence-based practice for regional mental health services.SettingThe Clinical Record Interactive Search (CRIS) system was used to extract personal identifiers who accessed psychiatric services between September 2007 and August 2013.ParticipantsA clinical cohort of 35 509 children and young people (aged 4–17 years).DesignMultiple government and ethical committees approved the link of clinical mental health service data to Department for Education (DfE) data on education and social care services. Under robust governance protocols, fuzzy and deterministic approaches were used by the DfE to match personal identifiers (names, date of birth and postcode) from National Pupil Database (NPD) and CRIS data sources.Outcome measuresRisk factors for non-matching to NPD were identified, and the potential impact of non-match biases on International Statistical Classification of Diseases, 10th Revision (ICD-10) classifications of mental disorder, and persistent school absence (<80% attendance) were examined. Probability weighting and adjustment methods were explored as methods to mitigate the impact of non-match biases.Results Governance challenges included developing a research protocol for data linkage, which met the legislative requirements for both National Health Service and DfE. From CRIS, 29 278 (82.5%) were matched to NPD school attendance records. Presenting to services in late adolescence (adjusted OR (aOR) 0.67, 95% CI 0.59 to 0.75) or outside of school census timeframes (aOR 0.15, 95% CI 0.14 to 0.17) reduced likelihood of matching. After adjustments for linkage error, ICD-10 mental disorder remained significantly associated with persistent school absence (aOR 1.13, 95% CI 1.07 to 1.22).ConclusionsThe work described sets a precedent for education data being used for medical benefit in England. Linkage between health and education records offers a powerful tool for evaluating the impact of mental health on school function, but biases due to linkage error may produce misleading results. Collaborative research with data providers is needed to develop linkage methods that minimise potential biases in analyses of linked data.</description><subject>Adolescent</subject><subject>Autism</subject><subject>Bias</subject><subject>Child</subject><subject>Child & adolescent mental health</subject><subject>Child, Preschool</subject><subject>Children & youth</subject><subject>Childrens health</subject><subject>Classification</subject><subject>Confidentiality</subject><subject>Databases, Factual</subject><subject>Education</subject><subject>Educational services</subject><subject>Electronic Health Records</subject><subject>Epidemiology</subject><subject>Evidence-Based Practice</subject><subject>Female</subject><subject>General Data Protection Regulation</subject><subject>Health services</subject><subject>Humans</subject><subject>Information Storage and Retrieval - methods</subject><subject>Linked Data</subject><subject>London</subject><subject>Longitudinal studies</subject><subject>Male</subject><subject>Medical Informatics</subject><subject>Medical research</subject><subject>Mental Health</subject><subject>Mental health care</subject><subject>Mental Health Services</subject><subject>Psychiatry</subject><subject>Psychosis</subject><subject>Psychotropic drugs</subject><subject>Public health</subject><subject>Public services</subject><subject>Records</subject><subject>Schools</subject><subject>Social Work</subject><subject>State Medicine</subject><subject>Teenagers</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNksuKFDEUhgtRnGGcJxAk4MaFNaaSSl1cCMMwXqDBhboOqeSkO206p0yqBvrhfLdJd7XD6MosciHf_-ec8BfFy4peVRVv3g27LY4QSkarrqSs5kI8Kc4ZreuyoUI8fbQ_Ky5T2tI8atELwZ4XZ5y2-dTR8-L3dSBqHCMqvSETEu_CTxfWBMys1eQwvCUJtVOeaBWBqGAIeNBTxOA02YDy04ZE0BhNIhYj0RvnTYRwRPc4Z68RcPRAXCDfcM74CoPB8J6o42tqDSRNs9kTtIv6KFUGPSQNYSK7POUCTo8liHdOAzFqUi-KZ1b5BJen9aL48fH2-83ncvX105eb61U51C2bSqVBt4abnnMuGga9Ytb0Ax0aVnWW2U4N2nSqHUA0-cf6hlrL6sZaLUzNdc8vig-L7zgPOzCHqqLycoxup-JeonLy75vgNnKNd7LhgrV9kw3enAwi_pohTXLncnPeqwA4J8mqthcVY5XI6Ot_0C3OMeT2DhQTTdfTNlN8oXTElCLYh2IqKg8JkaeEyENC5JKQrHr1uI8HzZ88ZOBqAbL6vxzvAYbezBE</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Downs, Johnny M</creator><creator>Ford, Tamsin</creator><creator>Stewart, Robert</creator><creator>Epstein, Sophie</creator><creator>Shetty, Hitesh</creator><creator>Little, Ryan</creator><creator>Jewell, Amelia</creator><creator>Broadbent, Matthew</creator><creator>Deighton, Jessica</creator><creator>Mostafa, Tarek</creator><creator>Gilbert, Ruth</creator><creator>Hotopf, Matthew</creator><creator>Hayes, Richard</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing 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approach to linking education, social care and electronic health records for children and young people in South London: a linkage study of child and adolescent mental health service data</title><author>Downs, Johnny M ; Ford, Tamsin ; Stewart, Robert ; Epstein, Sophie ; Shetty, Hitesh ; Little, Ryan ; Jewell, Amelia ; Broadbent, Matthew ; Deighton, Jessica ; Mostafa, Tarek ; Gilbert, Ruth ; Hotopf, Matthew ; Hayes, Richard</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b472t-acec7d3d9333562e9a2fd9b0b6218f2f8abcd8a7be56605960ff246ffc5d43c93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Autism</topic><topic>Bias</topic><topic>Child</topic><topic>Child & adolescent mental health</topic><topic>Child, Preschool</topic><topic>Children & youth</topic><topic>Childrens health</topic><topic>Classification</topic><topic>Confidentiality</topic><topic>Databases, Factual</topic><topic>Education</topic><topic>Educational services</topic><topic>Electronic Health Records</topic><topic>Epidemiology</topic><topic>Evidence-Based Practice</topic><topic>Female</topic><topic>General Data Protection Regulation</topic><topic>Health services</topic><topic>Humans</topic><topic>Information Storage and Retrieval - methods</topic><topic>Linked Data</topic><topic>London</topic><topic>Longitudinal studies</topic><topic>Male</topic><topic>Medical Informatics</topic><topic>Medical research</topic><topic>Mental Health</topic><topic>Mental health care</topic><topic>Mental Health Services</topic><topic>Psychiatry</topic><topic>Psychosis</topic><topic>Psychotropic drugs</topic><topic>Public health</topic><topic>Public services</topic><topic>Records</topic><topic>Schools</topic><topic>Social Work</topic><topic>State Medicine</topic><topic>Teenagers</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Downs, Johnny M</creatorcontrib><creatorcontrib>Ford, Tamsin</creatorcontrib><creatorcontrib>Stewart, Robert</creatorcontrib><creatorcontrib>Epstein, Sophie</creatorcontrib><creatorcontrib>Shetty, Hitesh</creatorcontrib><creatorcontrib>Little, Ryan</creatorcontrib><creatorcontrib>Jewell, Amelia</creatorcontrib><creatorcontrib>Broadbent, Matthew</creatorcontrib><creatorcontrib>Deighton, Jessica</creatorcontrib><creatorcontrib>Mostafa, Tarek</creatorcontrib><creatorcontrib>Gilbert, Ruth</creatorcontrib><creatorcontrib>Hotopf, Matthew</creatorcontrib><creatorcontrib>Hayes, Richard</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE 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Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Downs, Johnny M</au><au>Ford, Tamsin</au><au>Stewart, Robert</au><au>Epstein, Sophie</au><au>Shetty, Hitesh</au><au>Little, Ryan</au><au>Jewell, Amelia</au><au>Broadbent, Matthew</au><au>Deighton, Jessica</au><au>Mostafa, Tarek</au><au>Gilbert, Ruth</au><au>Hotopf, Matthew</au><au>Hayes, Richard</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An approach to linking education, social care and electronic health records for children and young people in South London: a linkage study of child and adolescent mental health service data</atitle><jtitle>BMJ open</jtitle><addtitle>BMJ Open</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>9</volume><issue>1</issue><spage>e024355</spage><epage>e024355</epage><pages>e024355-e024355</pages><issn>2044-6055</issn><eissn>2044-6055</eissn><abstract>ObjectivesCreation of linked mental health, social and education records for research to support evidence-based practice for regional mental health services.SettingThe Clinical Record Interactive Search (CRIS) system was used to extract personal identifiers who accessed psychiatric services between September 2007 and August 2013.ParticipantsA clinical cohort of 35 509 children and young people (aged 4–17 years).DesignMultiple government and ethical committees approved the link of clinical mental health service data to Department for Education (DfE) data on education and social care services. Under robust governance protocols, fuzzy and deterministic approaches were used by the DfE to match personal identifiers (names, date of birth and postcode) from National Pupil Database (NPD) and CRIS data sources.Outcome measuresRisk factors for non-matching to NPD were identified, and the potential impact of non-match biases on International Statistical Classification of Diseases, 10th Revision (ICD-10) classifications of mental disorder, and persistent school absence (<80% attendance) were examined. Probability weighting and adjustment methods were explored as methods to mitigate the impact of non-match biases.Results Governance challenges included developing a research protocol for data linkage, which met the legislative requirements for both National Health Service and DfE. From CRIS, 29 278 (82.5%) were matched to NPD school attendance records. Presenting to services in late adolescence (adjusted OR (aOR) 0.67, 95% CI 0.59 to 0.75) or outside of school census timeframes (aOR 0.15, 95% CI 0.14 to 0.17) reduced likelihood of matching. After adjustments for linkage error, ICD-10 mental disorder remained significantly associated with persistent school absence (aOR 1.13, 95% CI 1.07 to 1.22).ConclusionsThe work described sets a precedent for education data being used for medical benefit in England. Linkage between health and education records offers a powerful tool for evaluating the impact of mental health on school function, but biases due to linkage error may produce misleading results. Collaborative research with data providers is needed to develop linkage methods that minimise potential biases in analyses of linked data.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>30700480</pmid><doi>10.1136/bmjopen-2018-024355</doi><orcidid>https://orcid.org/0000-0002-2118-908X</orcidid><orcidid>https://orcid.org/0000-0002-8061-295X</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Autism Bias Child Child & adolescent mental health Child, Preschool Children & youth Childrens health Classification Confidentiality Databases, Factual Education Educational services Electronic Health Records Epidemiology Evidence-Based Practice Female General Data Protection Regulation Health services Humans Information Storage and Retrieval - methods Linked Data London Longitudinal studies Male Medical Informatics Medical research Mental Health Mental health care Mental Health Services Psychiatry Psychosis Psychotropic drugs Public health Public services Records Schools Social Work State Medicine Teenagers |
| title | An approach to linking education, social care and electronic health records for children and young people in South London: a linkage study of child and adolescent mental health service data |
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