Abstract
BackgroundComputerized Clinical Records, which are incorporated in primary health care practice, have great potential for research. In order to use this information, data quality and reliability must be assessed to prevent compromising the validity of the results.The aim of this study is to validate the diagnosis of hypertension and diabetes mellitus in the computerized clinical records of primary health care, taking the diagnosis criteria established in the most prominently used clinical guidelines as the gold standard against which what measure the sensitivity, specificity, and determine the predictive values.The gold standard for diabetes mellitus was the diagnostic criteria established in 2003 American Diabetes Association Consensus Statement for diabetic subjects. The gold standard for hypertension was the diagnostic criteria established in the Joint National Committee published in 2003.MethodsA cross-sectional multicentre validation study of diabetes mellitus and hypertension diagnoses in computerized clinical records of primary health care was carried out. Diagnostic criteria from the most prominently clinical practice guidelines were considered for standard reference.Sensitivity, specificity, positive and negative predictive values, and global agreement (with kappa index), were calculated. Results were shown overall and stratified by sex and age groups.ResultsThe agreement for diabetes mellitus with the reference standard as determined by the guideline was almost perfect (κ = 0.990), with a sensitivity of 99.53%, a specificity of 99.49%, a positive predictive value of 91.23% and a negative predictive value of 99.98%.Hypertension diagnosis showed substantial agreement with the reference standard as determined by the guideline (κ = 0.778), the sensitivity was 85.22%, the specificity 96.95%, the positive predictive value 85.24%, and the negative predictive value was 96.95%. Sensitivity results were worse in patients who also had diabetes and in those aged 70 years or over.ConclusionsOur results substantiate the validity of using diagnoses of diabetes and hypertension found within the computerized clinical records for epidemiologic studies.
Highlights
Computerized Clinical Records, which are incorporated in primary health care practice, have great potential for research
The aim of this study is to validate the diagnosis of HTN and diabetes mellitus (DM) coded in the Clinical Records (CCR) of primary health care (PHC), taking the diagnosis criteria established in the most prominently used clinical guidelines as the gold standard
The episodes are listed with an alphanumeric code, which corresponds to the International Classification of Primary Care (ICPC), and a description or clinical label
Summary
Computerized Clinical Records, which are incorporated in primary health care practice, have great potential for research. The aim of this study is to validate the diagnosis of hypertension and diabetes mellitus in the computerized clinical records of primary health care, taking the diagnosis criteria established in the most prominently used clinical guidelines as the gold standard against which what measure the sensitivity, specificity, and determine the predictive values. In recent decades, Computerized Clinical Records (CCR) are being used in the routine medical practice of primary health care (PHC) in the Spanish National Health System (NHS). The most widely used is the GPRD (General Practice Research Database), which contains information introduced prospectively since 1987 by more than 1,500 general practitioners (GPs) in the PHC of the United Kingdom and includes 7% of the population [5]. The GPRD has been widely used for research studies, with over 700 associated papers published up to date in peer-reviewed journals [5]
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