142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

Methods for comparing community based/real-world chronic disease interventions using electronic health record data

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Mary Masters, MSPH, MS , Health Studies, Westat, Rockville, MD
Introduction: Statistical techniques applied to data from real world primary care patients offer a guide for treatment choices among patients with multiple chronic conditions.  The assembly of a large sample of type II diabetic patient data from primary care electronic health records allowed analysis of a broad range of patients across combinations of demographics, co-morbidity, and concurrent medications.

Objectives:  For this study we developed a database in a real world primary care population while applying methods that resulted in an unbiased sample.

Methods:  Propensity score matching and adjustment for non-randomization of treatments were employed; the analysis considered large numbers of covariates, interventions, and outcomes. This database of type 2 diabetes patients included clinical data, physical and lab measures, concomitant medications, and International Classification of Disease, 9th revision coded medical problems. Methods of data cleaning included the review of frequencies to find extreme outlier values and combining similar categories to avoid small cell sizes.

Results: A cohort of 4,040 type 2 diabetes patients yielded statistically significant results when comparing the change in key indicator lab values across four oral treatment regimens. In covariate adjusted models, a diagnosis of hypertension made a significant contribution to predicting a change in HbA1c (p=0.0016) and the effective medication regimens differed among patients with and without hypertension.

Conclusions: Having a diagnosis of hypertension appeared to impact the change in HbA1c, which differed by treatment regimen.  The more effective regimen for T2DM appeared to be MET-TZD for patients with hypertension and MET-SU for patients without hypertension.

Learning Areas:

Basic medical science applied in public health
Biostatistics, economics
Chronic disease management and prevention
Clinical medicine applied in public health

Learning Objectives:
Compare interventions among patients with multiple chronic conditions while controlling for possible bias. Analyze electronic health record data from community based setting.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the project director of federally funded grants that have conducted epidemiological analysis of data from electronic health records and from other secondary data sources. Comparing patients with multiple chronic diseases is an area of special interest.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.