Going Beyond Administrative Data: Retrospective Evaluation of an Algorithm Using the Electronic Health Record to Help Identify Bleeding Events Among Hospitalized Medical Patients on Warfarin

James P. Moriarty, Paul R. Daniels, Dennis M. Manning, John G. O’Meara, Narith N. Ou, Tamara M. Berg, Jordan D. Haag, Daniel L. Roellinger, James M Naessens

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

To reliably assess quality, a standardized electronic approach is needed to identify bleeding events. The study aims were the following: (1) clinically validate an electronic health record–based algorithm for bleeding and (2) assess interrater results to determine validity and reliability. Data were analyzed before and after implementation of a pharmacist-managed warfarin protocol. Bleeding was based on ≥2 of 3 criteria: (1) diagnosis indicating bleeding, (2) lab value decrease suggesting bleeding, and (3) blood product use. All suspected bleeds (234) and a sample (58) not meeting criteria were compared with clinical review. There were 234 bleeding cases identified electronically. Reviewer agreement was 78.2% (κ = 0.565). Algorithm sensitivity was 93.9% and positive predictive value 46.2%. Algorithm identification was least accurate for those with only 2 criteria but good for those with all criteria. This study supports using multiple electronic criteria to identify bleeding events. However, cases having exactly 2 criteria may require manual review for validation.

Original languageEnglish (US)
Pages (from-to)391-396
Number of pages6
JournalAmerican Journal of Medical Quality
Volume32
Issue number4
DOIs
StatePublished - Jul 1 2017

Keywords

  • algorithms
  • electronic health records
  • hemorrhage
  • warfarin

ASJC Scopus subject areas

  • Health Policy

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