Online Program

331183
Validation of the use of electronic health records for ADHD case identification


Tuesday, November 3, 2015 : 1:10 p.m. - 1:30 p.m.

Siobhan Gruschow, MPH, Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA
Melissa Pfeiffer, MPH, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
Benjamin Yerys, PhD, Center for Autism Research, Children's Hospital of Philadelphia, Philadelphia, PA
Ligia Antezana, BS, Children's Hospital of Philadelphia, Philadelphia, PA
Flaura Winston, MD, PhD, Children's Hospital of Philadelphia, Philadelphia, PA
Thomas Power, PhD, Children's Hospital of Philadelphia, Philadelphia, PA
Patty Huang, MD, Children's Hospital of Philadelphia, Philadelphia, PA
Allison Curry, PhD, Center for Injury Research and Prevention, The Children's Hospital of Philadelphia, Philadelphia, PA
background: Epidemiological studies of administrative databases (e.g., Medicaid) often rely on ICD-9 codes for case identification. However, the data included in electronic health records (EHR) may enhance our ability to validly identify cases. Our objective was to validate the use of EHRs in identifying cases of ADHD within a large pediatric healthcare network.  

 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
Epidemiology

Learning Objectives:
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

Presenting author's disclosure statement:

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.