Abstract P176: Reliability Of The Electronic Health Record’s Problem List In Describing Multimorbidity In Patients With Heart Failure In The Emergency Department

Abstract

Introduction: Patients with heart failure (HF) often suffer from multimorbidity, the co-occurrence of two or more chronic conditions. Electronic health records (EHRs) store data on chronic conditions within the problem list, which can be readily extracted for research purposes. Objective: To assess the reliability in using the EHR-based problem list to identify comorbid conditions among patients with HF in the emergency department. Methods: A retrospective chart review study was performed on a random sample of 200 patients age >65 years with a diagnosis of HF who presented to an academic emergency department (ED) in 2019 (mean age 78.3 years old, 52.5% women). Manual chart review was performed by a trained medical student (BK) as the gold standard in identifying additional chronic conditions in patients with HF. All diagnoses were mapped to International Classification of Diseases, Tenth Revision, Clinical Modification diagnostic codes and classified into 38 domains using the Agency for Healthcare Research Quality’s Elixhauser Comorbidity Software. We computed sensitivity, specificity, positive predictive value, and negative predictive value of using the EHR’s problem list to capture each domain. We calculated the intra-class correlation coefficient (ICC) to estimate reliability in the total number of domains captured by each method. Results: Our chart review found that patients with HF had a mean of 5.4 chronic conditions (SD 2.1). In comparison, the EHR's problem list identified a mean of 4.0 chronic conditions (SD 2.0). The five most prevalent domains were hypertension, diabetes, obesity, chronic pulmonary disease, and renal failure. Specificities for the five most prevalent domains were at least 97% whereas sensitivities were considerably lower and varied widely (28.6%-80.7%; Table 1). The ICC comparing chart review to the problem list was 0.77 (95% CI: 0.68-0.80). Conclusion: Multimorbidity in patients with HF in the ED was captured with good reliability using the EHR problem list.