电子表型在儿科初级保健中区分临床医生对高体重指数、高血压、脂质紊乱、脂肪肝和糖尿病的关注:电子表型与蒙面综合图表比较的诊断准确性

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Obesity Pub Date : 2023-07-17 DOI:10.1111/ijpo.13066

Christy B. Turer, Jenny J. Park, Olga T. Gupta, Charina Ramirez, Mujeeb A. Basit, Daniel F. Heitjan, Sarah E. Barlow

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引用次数: 0

摘要

背景/目的电子表型是一种利用电子健康记录(EHR)数据自动识别具有感兴趣特征的患者/人群的方法。本研究确定了使用超重/肥胖儿童的电子病历数据对临床医生“关注”高体重指数(BMI)和四种不同合并症的电子表型证据的有效性。方法通过电子/健康记录证据对2-18岁超重/肥胖儿童(n = 17,397)建立5种电子表型，对高体重指数、高血压、脂质紊乱、脂肪肝和前驱糖尿病/糖尿病进行分类。我们回顾、选择和交叉核对随机图表，以确定临床医生在电子病历中选择的项目，以建立问题清单，并订购药物、实验室测试和转诊，以电子方式对超重/肥胖和每种合并症的关注进行分类。每个临床医生注意表型的操作特征是通过比较综合图表审查来确定的，这些审查是由电子分类的审查员进行的，审查员裁定临床医生注意高BMI和每种合并症的证据。结果在817份随机抽样的就诊记录中，每种电子表型的特异性为99%-100% (ppv范围从糖尿病前期/糖尿病的96.8%到血脂异常和高血压的100%)。注意分类的敏感性从高血压的69% (NPV, 98.9%)到高bmi注意的84.7% (NPV, 92.3%)不等。结论电子表型对临床医生对超重/肥胖和不同合并症的关注具有高度特异性，具有中等(BMI)至中等(每种合并症)的敏感性。高特异性支持使用表型来识别先前有高bmi /合并症注意的儿童。

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Electronic phenotypes to distinguish clinician attention to high body mass index, hypertension, lipid disorders, fatty liver and diabetes in pediatric primary care: Diagnostic accuracy of electronic phenotypes compared to masked comprehensive chart review

Background/Objectives

Electronic phenotyping is a method of using electronic-health-record (EHR) data to automate identifying a patient/population with a characteristic of interest. This study determines validity of using EHR data of children with overweight/obesity to electronically phenotype evidence of clinician ‘attention’ to high body mass index (BMI) and each of four distinct comorbidities.

Methods

We built five electronic phenotypes classifying 2-18-year-old children with overweight/obesity (n = 17,397) by electronic/health-record evidence of distinct attention to high body mass index, hypertension, lipid disorders, fatty liver, and prediabetes/diabetes. We reviewed, selected and cross-checked random charts to define items clinicians select in EHRs to build problem lists, and to order medications, laboratory tests and referrals to electronically classify attention to overweight/obesity and each comorbidity. Operating characteristics of each clinician-attention phenotype were determined by comparing comprehensive chart review by reviewers masked to electronic classification who adjudicated evidence of clinician attention to high BMI and each comorbidity.

Results

In a random sample of 817 visit-records reviewed/coded, specificity of each electronic phenotype is 99%–100% (with PPVs ranging from 96.8% for prediabetes/diabetes to 100% for dyslipidemia and hypertension). Sensitivities of the attention classifications range from 69% for hypertension (NPV, 98.9%) to 84.7% for high-BMI attention (NPV, 92.3%).

Conclusions

Electronic phenotypes for clinician attention to overweight/obesity and distinct comorbidities are highly specific, with moderate (BMI) to modest (each comorbidity) sensitivity. The high specificity supports using phenotypes to identify children with prior high-BMI/comorbidity attention.

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来源期刊

Pediatric Obesity PEDIATRICS-

CiteScore

7.30

自引率

5.30%

发文量

117

审稿时长

6-12 weeks

期刊介绍： Pediatric Obesity is a peer-reviewed, monthly journal devoted to research into obesity during childhood and adolescence. The topic is currently at the centre of intense interest in the scientific community, and is of increasing concern to health policy-makers and the public at large. Pediatric Obesity has established itself as the leading journal for high quality papers in this field, including, but not limited to, the following: Genetic, molecular, biochemical and physiological aspects of obesity – basic, applied and clinical studies relating to mechanisms of the development of obesity throughout the life course and the consequent effects of obesity on health outcomes Metabolic consequences of child and adolescent obesity Epidemiological and population-based studies of child and adolescent overweight and obesity Measurement and diagnostic issues in assessing child and adolescent adiposity, physical activity and nutrition Clinical management of children and adolescents with obesity including studies of treatment and prevention Co-morbidities linked to child and adolescent obesity – mechanisms, assessment, and treatment Life-cycle factors eg familial, intrauterine and developmental aspects of child and adolescent obesity Nutrition security and the "double burden" of obesity and malnutrition Health promotion strategies around the issues of obesity, nutrition and physical activity in children and adolescents Community and public health measures to prevent overweight and obesity in children and adolescents.