Database queries for hospitalizations for acute congestive heart failure: Flexible methods and validation based on set theory

Marc Rosenman, Jinghua He, Joel Martin, Kavitha Nutakki, George Eckert, Kathleen Lane, Irmina Gradus-Pizlo, Siu Hui

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background and objective: Electronic health records databases are increasingly used for identifying cohort populations, covariates, or outcomes, but discerning such clinical 'phenotypes' accurately is an ongoing challenge. We developed a flexible method using overlapping (Venn diagram) queries. Here we describe this approach to find patients hospitalized with acute congestive heart failure (CHF), a sampling strategy for one-by-one 'gold standard' chart review, and calculation of positive predictive value (PPV) and sensitivities, with SEs, across different definitions. Materials and methods: We used retrospective queries of hospitalizations (2002-2011) in the Indiana Network for Patient Care with any CHF ICD-9 diagnoses, a primary diagnosis, an echocardiogram performed, a B-natriuretic peptide (BNP) drawn, or BNP > 500 pg/mL. We used a hybrid between proportional sampling by Venn zone and over-sampling non-overlapping zones. The acute CHF ( presence/absence) outcome was based on expert chart review using a priori criteria. Results: Among 79 091 hospitalizations, we reviewed 908. A query for any ICD-9 code for CHF had PPV 42.8% (SE 1.5%) for acute CHF and sensitivity 94.3% (1.3%). Primary diagnosis of 428 and BNP >500 pg/mL had PPV 90.4% (SE 2.4%) and sensitivity 28.8% (1.1%). PPV was <10% when there was no echocardiogram, no BNP, and no primary diagnosis. 'False positive' hospitalizations were for other heart disease, lung disease, or other reasons. Conclusions: This novel method successfully allowed flexible application and validation of queries for patients hospitalized with acute CHF.

Original languageEnglish
Pages (from-to)345-352
Number of pages8
JournalJournal of the American Medical Informatics Association
Volume21
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Natriuretic Peptides
Hospitalization
Heart Failure
Databases
International Classification of Diseases
Electronic Health Records
Lung Diseases
Heart Diseases
Patient Care
Phenotype
Population

ASJC Scopus subject areas

  • Health Informatics

Cite this

Database queries for hospitalizations for acute congestive heart failure : Flexible methods and validation based on set theory. / Rosenman, Marc; He, Jinghua; Martin, Joel; Nutakki, Kavitha; Eckert, George; Lane, Kathleen; Gradus-Pizlo, Irmina; Hui, Siu.

In: Journal of the American Medical Informatics Association, Vol. 21, No. 2, 2014, p. 345-352.

Research output: Contribution to journalArticle

Rosenman, Marc ; He, Jinghua ; Martin, Joel ; Nutakki, Kavitha ; Eckert, George ; Lane, Kathleen ; Gradus-Pizlo, Irmina ; Hui, Siu. / Database queries for hospitalizations for acute congestive heart failure : Flexible methods and validation based on set theory. In: Journal of the American Medical Informatics Association. 2014 ; Vol. 21, No. 2. pp. 345-352.
@article{d7e438f0e24c4110b3f34083b7adf66c,
title = "Database queries for hospitalizations for acute congestive heart failure: Flexible methods and validation based on set theory",
abstract = "Background and objective: Electronic health records databases are increasingly used for identifying cohort populations, covariates, or outcomes, but discerning such clinical 'phenotypes' accurately is an ongoing challenge. We developed a flexible method using overlapping (Venn diagram) queries. Here we describe this approach to find patients hospitalized with acute congestive heart failure (CHF), a sampling strategy for one-by-one 'gold standard' chart review, and calculation of positive predictive value (PPV) and sensitivities, with SEs, across different definitions. Materials and methods: We used retrospective queries of hospitalizations (2002-2011) in the Indiana Network for Patient Care with any CHF ICD-9 diagnoses, a primary diagnosis, an echocardiogram performed, a B-natriuretic peptide (BNP) drawn, or BNP > 500 pg/mL. We used a hybrid between proportional sampling by Venn zone and over-sampling non-overlapping zones. The acute CHF ( presence/absence) outcome was based on expert chart review using a priori criteria. Results: Among 79 091 hospitalizations, we reviewed 908. A query for any ICD-9 code for CHF had PPV 42.8{\%} (SE 1.5{\%}) for acute CHF and sensitivity 94.3{\%} (1.3{\%}). Primary diagnosis of 428 and BNP >500 pg/mL had PPV 90.4{\%} (SE 2.4{\%}) and sensitivity 28.8{\%} (1.1{\%}). PPV was <10{\%} when there was no echocardiogram, no BNP, and no primary diagnosis. 'False positive' hospitalizations were for other heart disease, lung disease, or other reasons. Conclusions: This novel method successfully allowed flexible application and validation of queries for patients hospitalized with acute CHF.",
author = "Marc Rosenman and Jinghua He and Joel Martin and Kavitha Nutakki and George Eckert and Kathleen Lane and Irmina Gradus-Pizlo and Siu Hui",
year = "2014",
doi = "10.1136/amiajnl-2013-001942",
language = "English",
volume = "21",
pages = "345--352",
journal = "Journal of the American Medical Informatics Association : JAMIA",
issn = "1067-5027",
publisher = "Oxford University Press",
number = "2",

}

TY - JOUR

T1 - Database queries for hospitalizations for acute congestive heart failure

T2 - Flexible methods and validation based on set theory

AU - Rosenman, Marc

AU - He, Jinghua

AU - Martin, Joel

AU - Nutakki, Kavitha

AU - Eckert, George

AU - Lane, Kathleen

AU - Gradus-Pizlo, Irmina

AU - Hui, Siu

PY - 2014

Y1 - 2014

N2 - Background and objective: Electronic health records databases are increasingly used for identifying cohort populations, covariates, or outcomes, but discerning such clinical 'phenotypes' accurately is an ongoing challenge. We developed a flexible method using overlapping (Venn diagram) queries. Here we describe this approach to find patients hospitalized with acute congestive heart failure (CHF), a sampling strategy for one-by-one 'gold standard' chart review, and calculation of positive predictive value (PPV) and sensitivities, with SEs, across different definitions. Materials and methods: We used retrospective queries of hospitalizations (2002-2011) in the Indiana Network for Patient Care with any CHF ICD-9 diagnoses, a primary diagnosis, an echocardiogram performed, a B-natriuretic peptide (BNP) drawn, or BNP > 500 pg/mL. We used a hybrid between proportional sampling by Venn zone and over-sampling non-overlapping zones. The acute CHF ( presence/absence) outcome was based on expert chart review using a priori criteria. Results: Among 79 091 hospitalizations, we reviewed 908. A query for any ICD-9 code for CHF had PPV 42.8% (SE 1.5%) for acute CHF and sensitivity 94.3% (1.3%). Primary diagnosis of 428 and BNP >500 pg/mL had PPV 90.4% (SE 2.4%) and sensitivity 28.8% (1.1%). PPV was <10% when there was no echocardiogram, no BNP, and no primary diagnosis. 'False positive' hospitalizations were for other heart disease, lung disease, or other reasons. Conclusions: This novel method successfully allowed flexible application and validation of queries for patients hospitalized with acute CHF.

AB - Background and objective: Electronic health records databases are increasingly used for identifying cohort populations, covariates, or outcomes, but discerning such clinical 'phenotypes' accurately is an ongoing challenge. We developed a flexible method using overlapping (Venn diagram) queries. Here we describe this approach to find patients hospitalized with acute congestive heart failure (CHF), a sampling strategy for one-by-one 'gold standard' chart review, and calculation of positive predictive value (PPV) and sensitivities, with SEs, across different definitions. Materials and methods: We used retrospective queries of hospitalizations (2002-2011) in the Indiana Network for Patient Care with any CHF ICD-9 diagnoses, a primary diagnosis, an echocardiogram performed, a B-natriuretic peptide (BNP) drawn, or BNP > 500 pg/mL. We used a hybrid between proportional sampling by Venn zone and over-sampling non-overlapping zones. The acute CHF ( presence/absence) outcome was based on expert chart review using a priori criteria. Results: Among 79 091 hospitalizations, we reviewed 908. A query for any ICD-9 code for CHF had PPV 42.8% (SE 1.5%) for acute CHF and sensitivity 94.3% (1.3%). Primary diagnosis of 428 and BNP >500 pg/mL had PPV 90.4% (SE 2.4%) and sensitivity 28.8% (1.1%). PPV was <10% when there was no echocardiogram, no BNP, and no primary diagnosis. 'False positive' hospitalizations were for other heart disease, lung disease, or other reasons. Conclusions: This novel method successfully allowed flexible application and validation of queries for patients hospitalized with acute CHF.

UR - http://www.scopus.com/inward/record.url?scp=84894052968&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84894052968&partnerID=8YFLogxK

U2 - 10.1136/amiajnl-2013-001942

DO - 10.1136/amiajnl-2013-001942

M3 - Article

C2 - 24113802

AN - SCOPUS:84894052968

VL - 21

SP - 345

EP - 352

JO - Journal of the American Medical Informatics Association : JAMIA

JF - Journal of the American Medical Informatics Association : JAMIA

SN - 1067-5027

IS - 2

ER -