Would you like to add a weight after this blood pressure, doctor? Discovery of potentially actionable associations between the provision of multiple screens in primary care.

Sumeet Kalia,Christopher Meaney,Michelle Greiver,Rahim Moineddin,Babak Aliarzadeh,Frank Sullivan,Eva Grunfeld,Xu Zhao

doi:10.1111/jep.12877

Abstract

Rationale, aims, and objectiveGuidelines recommend screening for risk factors associated with chronic diseases but current electronic prompts have limited effects. Our objective was to discover and rank associations between the presence of screens to plan more efficient prompts in primary care.MethodsRisk factors with the greatest impact on chronic diseases are associated with blood pressure, body mass index, waist circumference, glycaemic and lipid levels, smoking, alcohol use, diet, and exercise. We looked for associations between the presence of screens for these in electronic medical records. We used association rule mining to describe relationships among items, factor analysis to find latent categories, and Cronbach α to quantify consistency within latent categories.ResultsData from 92 140 patients in or around Toronto, Ontario, were included. We found positive correlations (lift >1) between the presence of all screens. The presence of any screen was associated with confidence greater than 80% that other data on items with high prevalence (blood pressure, glycaemic and lipid levels, or smoking) would also be present. A cluster of rules predicting the presence of blood pressure were ranked highest using measures of interestingness such as standardized lift. We found 3 latent categories using factor analysis; these were laboratory tests, vital signs, and lifestyle factors; Cronbach α ranged between .58 for lifestyle factors and .88 for laboratory tests.ConclusionsAssociations between the provision of important screens can be discovered and ranked. Rules with promising combinations of associated screens could be used to implement data driven alerts.

Highlights

Chronic diseases are the leading causes of mortality and morbidity in upper middle and high‐income countries.[1]
While there is some controversy about the frequency with which these data elements should be recorded, frequently proposed intervals and standards for most patients are at least every 2 years for vital signs (BP, waist circumference (WC), and body mass index (BMI)) and at least every 3 years for laboratory tests, recorded information about lifestyle risk factors in a summary health profile.[10]
High support was recorded for bivariate rules that predicted the presence of data on blood pressure (BP), smoking, low‐density lipoprotein (LDL), or haemoglobin A1c (A1c)

Summary

Introduction

Chronic diseases are the leading causes of mortality and morbidity in upper middle and high‐income countries.[1]. While there is some controversy about the frequency with which these data elements should be recorded, frequently proposed intervals and standards for most patients are at least every 2 years for vital signs (BP, WC, and BMI) and at least every 3 years for laboratory tests (fasting blood glucose/A1c and LDL), recorded information about lifestyle risk factors in a summary health profile.[10]

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Conclusion