Clinical ResearchValidity of Administrative Data for Identifying Patients Who Have Had a Stroke or Transient Ischemic Attack Using EMRALD as a Reference Standard
Section snippets
Methods
The Electronic Medical Record Administrative Data Linked Database (EMRALD) held at the Institute for Clinical Evaluative Sciences was used as the reference standard for the diagnosis of stroke or TIA. EMRALD consists of all clinically relevant information contained in the family physician patient chart of volunteering family physicians in Ontario using Practice Solutions EMR. The data used in this validation study were extracted between June 2011 and November 2011. Patients in this database are
Results
For the 5000 adult patients randomly sampled for chart abstraction, the average age was 51.5 years and 57.5% were women. Among the 83 physicians practicing in 26 geographically distinct clinics, the average years in practice was 18.4 years and the average length of time using EMR was 5.6 years. Overall, the prevalence of stroke in our population was 2.1%, for TIA it was 1.6%, and for stroke and TIA combined it was 3.0%. We found that 61 (59%) of the patients had ischemic strokes, 12 (12%) of
Discussion
We found the ideal algorithm to identify patients who had a stroke or stroke or TIA, or both, was hospitalization or 2 physician billings within a 1-year period. For the identification of patients who had a TIA, the ideal algorithm was 1 hospitalization or emergency department visit or 2 physician billings within 1 year. We found that about 40% of strokes and 20% of TIAs identified using administrative data sources were only identified through physician billing data and were likely milder cases
Acknowledgements
We would like to thank Asako Bienek for her help with the conceptual design and critical review of this manuscript.
This study was supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should
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