Validation of the use of electronic health records for ADHD case identification
methods: We reviewed EHRs of a randomly selected sample of patients who were born 1987-1995 and were patients of CHOP’s New Jersey network. Four hierarchical, mutually exclusive groups of patients were selected for review: (1) had an ADHD ICD-9 diagnostic code in an office visit (total n= 7,567; 172 sampled); (2) ADHD ICD-9 code was listed as an ongoing problem (total n=302; 30 sampled); (3) were prescribed an ADHD medication (total n=880; 88 sampled); and (4) had a keyword (e.g., “ADHD,” “hyperactivity”) in qualitative descriptions of visits (total n=3,055; 161 sampled).
results: Of the patients with an ADHD-related visit, we confirmed case status (via at least one independent source, e.g., letter) in 26.7% and confirmed non-case status in 1.7%. None of the reviewed patients with ADHD listed as a chronic diagnosis were found to be non-cases. Medication and keyword searches in absence of ICD-9 codes did not yield additional confirmed cases of ADHD.
conclusions: Use of EHRs is a valid method for ADHD case identification when based on both visit-level and chronic ADHD ICD-9 diagnostic codes, although misclassification may still exist. Conducting validation exercises is necessary to measure the extent of misclassification and bias of effect estimates.
Learning Areas:Conduct evaluation related to programs, research, and other areas of practice
Evaluate the validity of electronic health records (EHR) to identify cases of Attention Deficit Hyperactivity Disorder in a large, regional pediatric healthcare network
Keyword(s): Children With Special Needs, Epidemiology
Qualified on the content I am responsible for because: I am an MPH-train epidemiologist with to years of experience in public health research, with a focus on data management and validity of large databases.
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.