PROMOTING EVIDENCE-BASED ASTHMA DIAGNOSIS AND SURVEILLANCE USING ELECTRONIC TOOLS
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Authors
Moloney, Max
Date
Type
thesis
Language
eng
Keyword
Asthma , Electronic medical records , Quality improvement , Knowledge translation
Alternative Title
Abstract
Background: In Canada, asthma is one of the most common chronic conditions. It is estimated that approximately 3.8 million people in Canada suffer from asthma. The majority of asthma diagnoses and care take place in primary care settings. Electronic tools (eTools) offer an opportunity to utilize technology to improve asthma diagnosis and surveillance.
Purpose: The purpose of this study was to create and validate a case definition or separate case definitions for suspected and confirmed asthma in primary care electronic medical records (EMRs) for use in eTools and to understand how to develop and scale a primary care surveillance system for quality improvement of asthma diagnosis and care.
Methods: A respirologist, family physician, and trainee manually classified 776 adult patient charts from a primary care practice EMR in Kingston, Ontario as suspected asthma, confirmed asthma, or not asthma using Canadian Thoracic Society criteria. Case definitions based on billing codes, clinical data elements and medications were applied to the site’s Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data for the same charts and compared to abstractor classifications to determine each case definition’s measurement properties. Opportunities and barriers to developing and scaling eTools for asthma were determined through two focus groups using a mixed-methods approach.
Results: The prevalence of suspected and confirmed asthma were 7.3% (n=54) and 2.4% (n=18) respectively in this study. Case definitions based on this EMR dataset could not distinguish between suspected and confirmed asthma. One case definition consisting of billing, clinical, and medication elements had the best measurement properties for suspected or confirmed asthma with a sensitivity of 81%, specificity of 90%, positive predictive value of 45%, negative predictive value of 98%, and Youden’s Index of 0.71 for combined suspected or confirmed asthma cases. A total of 7 key themes important to the development of a surveillance tool were identified through mixed-methods analysis.
Conclusions: An EMR case definition for suspected or confirmed adult asthma has been validated for use in a CPCSSN database. Implementation of this case definition in conjunction with developing new eTools that address the key themes identified in this study will enable the development of a primary care surveillance system for quality improvement in adult asthma care. Adoption of EMR data elements that document asthma diagnosis status is warranted and would greatly enhance such a system
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Attribution-NonCommercial-NoDerivs 3.0 United States
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NonCommercial-NoDerivs 3.0 United States