TY - JOUR
T1 - Identifying opioid use disorder in the emergency department
T2 - Multi-system electronic health record-based computable phenotype derivation and validation study
AU - Chartash, David
AU - Paek, Hyung
AU - Dziura, James D.
AU - Ross, Bill K.
AU - Nogee, Daniel P.
AU - Boccio, Eric
AU - Hines, Cory
AU - Schott, Aaron M.
AU - Jeffery, Molly M.
AU - Patel, Mehul D.
AU - Platts-Mills, Timothy F.
AU - Ahmed, Osama
AU - Brandt, Cynthia
AU - Couturier, Katherine
AU - Melnick, Edward
N1 - Publisher Copyright:
© 2019 JMIR Publications Inc.. All right reserved.
PY - 2019/10
Y1 - 2019/10
N2 - Background: Deploying accurate computable phenotypes in pragmatic trials requires a trade-off between precise and clinically sensical variable selection. In particular, evaluating the medical encounter to assess a pattern leading to clinically significant impairment or distress indicative of disease is a difficult modeling challenge for the emergency department. Objective: This study aimed to derive and validate an electronic health record-based computable phenotype to identify emergency department patients with opioid use disorder using physician chart review as a reference standard. Methods: A 2-algorithm computable phenotype was developed and evaluated using structured clinical data across 13 emergency departments in 2 large health care systems. Algorithm 1 combined clinician and billing codes. Algorithm 2 used chief complaint structured data suggestive of opioid use disorder. To evaluate the algorithms in both internal and external validation phases, 2 emergency medicine physicians, with a third acting as adjudicator, reviewed a pragmatic sample of 231 charts: 125 internal validation (75 positive and 50 negative), 106 external validation (56 positive and 50 negative). Results: Cohen kappa, measuring agreement between reviewers, for the internal and external validation cohorts was 0.95 and 0.93, respectively. In the internal validation phase, Algorithm 1 had a positive predictive value (PPV) of 0.96 (95% CI 0.863-0.995) and a negative predictive value (NPV) of 0.98 (95% CI 0.893-0.999), and Algorithm 2 had a PPV of 0.8 (95% CI 0.593-0.932) and an NPV of 1.0 (one-sided 97.5% CI 0.863-1). In the external validation phase, the phenotype had a PPV of 0.95 (95% CI 0.851-0.989) and an NPV of 0.92 (95% CI 0.807-0.978). Conclusions: This phenotype detected emergency department patients with opioid use disorder with high predictive values and reliability. Its algorithms were transportable across health care systems and have potential value for both clinical and research purposes.
AB - Background: Deploying accurate computable phenotypes in pragmatic trials requires a trade-off between precise and clinically sensical variable selection. In particular, evaluating the medical encounter to assess a pattern leading to clinically significant impairment or distress indicative of disease is a difficult modeling challenge for the emergency department. Objective: This study aimed to derive and validate an electronic health record-based computable phenotype to identify emergency department patients with opioid use disorder using physician chart review as a reference standard. Methods: A 2-algorithm computable phenotype was developed and evaluated using structured clinical data across 13 emergency departments in 2 large health care systems. Algorithm 1 combined clinician and billing codes. Algorithm 2 used chief complaint structured data suggestive of opioid use disorder. To evaluate the algorithms in both internal and external validation phases, 2 emergency medicine physicians, with a third acting as adjudicator, reviewed a pragmatic sample of 231 charts: 125 internal validation (75 positive and 50 negative), 106 external validation (56 positive and 50 negative). Results: Cohen kappa, measuring agreement between reviewers, for the internal and external validation cohorts was 0.95 and 0.93, respectively. In the internal validation phase, Algorithm 1 had a positive predictive value (PPV) of 0.96 (95% CI 0.863-0.995) and a negative predictive value (NPV) of 0.98 (95% CI 0.893-0.999), and Algorithm 2 had a PPV of 0.8 (95% CI 0.593-0.932) and an NPV of 1.0 (one-sided 97.5% CI 0.863-1). In the external validation phase, the phenotype had a PPV of 0.95 (95% CI 0.851-0.989) and an NPV of 0.92 (95% CI 0.807-0.978). Conclusions: This phenotype detected emergency department patients with opioid use disorder with high predictive values and reliability. Its algorithms were transportable across health care systems and have potential value for both clinical and research purposes.
KW - Algorithms
KW - Electronic health records
KW - Emergency medicine
KW - Opioid-related disorders
KW - Phenotype
UR - http://www.scopus.com/inward/record.url?scp=85085468744&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85085468744&partnerID=8YFLogxK
U2 - 10.2196/15794
DO - 10.2196/15794
M3 - Article
AN - SCOPUS:85085468744
SN - 2291-9694
VL - 7
JO - JMIR Medical Informatics
JF - JMIR Medical Informatics
IS - 4
M1 - e15794
ER -