Background
Methods
Basic model of primary health care EMR data quality
Conceptualizing data quality domains
Developing the data quality measures
Operationalizing the data quality measures
Domain | Measure | Operationalization of Measure |
---|---|---|
Comparability | Comparison of Database Population to a Standard Population | ∙ Compare age-sex structure of the database population to an external/standard population (e.g. population census) using 5 year age bands, graph results ∘ Statistical test: Chi Square by patient age and sex ∙ Compute the mean and median age by sex for the database population and compare to an external/standard population |
Concordance of Test Conditions | ∙ Compute crude and age standardized prevalence of test conditions (diabetes mellitus, hypothyroidism, hypertension, asthma, urinary tract infection, and obesity) within the database population, compare to published prevalence figures for the test conditions | |
Completeness | Sensitivity | ∙ Calculate sensitivity values for test conditions of diabetes mellitus, hypertension, hypothyroidism, asthma, obesity and urinary tract infection. Use test condition definitions as the gold standard and billing code as the comparison standard. |
“Consistency of Capture” [46] | ∙ Calculate: ∙ Percentage of all patients with 1 or more entries on problem list ∙ Percentage of all patients with 1 or more entries on allergy record, including “no allergies” ∙ Percentage of patients visiting in the last year of the database with 1 or more prescribed medications | |
Recording of Blood Pressure, Height, and Weight | ∙ Calculate proportion of patients with: ∙ 1 or more blood pressure recordings for patients 18 + years, males and females ∙ 1 or more height recordings for patients of all ages, males and females ∙ 1 or more weight recording for patients of all ages, males and females ∙ Statistical test: Chi Square by patient age and sex | |
Recording of Blood Pressure among Patients Requiring a Blood Pressure Measurement | ∙ Calculate: ∙ Percentage of patients with diabetes mellitus, with 1 or more blood pressure recordings within 12 months of date of onset of diabetes ∙ Percentage of patients with hypertension medications (2 or more oral anti-hypertensives, or 1 or more diuretics) with 1 or more blood pressure recordings within 12 months of date of onset of hypertension | |
Correctness | Positive Predictive Value | ∙ Calculate positive predictive values (using same approach as for sensitivity) for test conditions of diabetes mellitus, hypertension, hypothyroidism, asthma, obesity and urinary tract infection |
Unlikely Combinations of Age & Specific Procedures | ∙ Calculate the percentage of patients 10 or more years of age with a tetanus toxoid conjugate vaccine (diphtheria, haemophilus B, pertussis, polio, and tetanus) (which is usually reserved for children < 10 years of age) | |
Currency | Timeliness of Weight Recording for Patients with Obesity | ∙ Calculate the percentage of obese patients with 1 or more weight recordings within 1 year of last visit in recorded in the database |
Timeliness of Visit for Pregnancy | ∙ Calculate percentage of patients with a positive pregnancy laboratory test result and 1 or more visits within two months of the result | |
Timeliness of Blood Pressure, Height, and Weight Recording | Calculate proportion of patients with values recorded no more than one year prior to their last visit in the database for: ∙ 1 or more blood pressure recordings for patients 18 + years, males and females ∙ 1 or more height recordings for patients of all ages, males and females ∙ 1 or more weight recording for patients of all ages, males and females Statistical test: Chi Square by patient age and sex |
Testing of the data quality measures
Dataset A | Dataset B | Dataset C | ||||
---|---|---|---|---|---|---|
Years of Data | January 1, 2006-December 31, 2015 | July 1, 2010-June 30, 2014 | March 1, 2006-June 30, 2010 | |||
# | % | # | % | # | % | |
Sex | ||||||
Males | 14,619 | 47.2% | 1126 | 45.6% | 6614 | 45.9% |
Females | 16,381 | 52.8% | 1346 | 54.4% | 7782 | 54.1% |
Total | 31,000 | 100.0% | 2472 | 100.0% | 14,396 | 100.0% |
Missing Sex | 5 | 0 | 0 | |||
Age | As of January 1, 2006 | As of July 1, 2010 | As of March 1, 2006 | |||
Mean | 39.4 | 48.7 | 38.4 | |||
Median | 41 | 53 | 38 | |||
Missing Age | 1367 | 0 | 5 |
Results
Data quality assessment
Comparability
Results | |||||
---|---|---|---|---|---|
Measure | Dataset A | Dataset B | Dataset C | ||
Comparison of Database Population with Standard Population | Chi Square by patient age and sex to the 2006 Canadian Censusa | p = < 0.001 | p = < 0.001 | p = < 0.001 | |
Canadian Census Mean (median) age | |||||
Mean (median) age | 39.4 (41.0) | 48.7 (53.0) | 38.4 (38.0) | (39.5)b | |
Prevalence, Crude % (Age Standardized %; 95% confidence intervalc) | Published Prevalence % | ||||
Concordance of TestConditions | Diabetes | 13.8 (11.3; 11.0–11.7) | 12.4 (9.0; 7.9–10.1) | d | 6.8e |
Hypertension | 42.0 (35.5; 35.0–36.0) | 23.9 (14.9; 13.5–16.3) | 29.8 (20.8; 20.1–21.5) | 19.1f | |
Hypothyroidism | 7.5 (6.5; 6.2–6.8) | 7.3 (5.9; 5.0–6.8) | 5.5 (4.1; 3.8–4.4) | 7.1g | |
Asthmah | 5.6 | * | 5.0 | 21.1i | |
Obesity | 35.2 (36.2; 35.7–36.7) | 20.9 (18.7; 17.2–20.2) | 24.2 (23.5; 22.8–24.2) | 24.1j | |
Urinary Tract Infection | 6.9 (6.6; 6.3–6.9) | * | 0.9 (0.8; 0.7–1.0) | k |
Completeness
Results (%) | ||||
---|---|---|---|---|
Measure | Dataset A | Dataset B | Dataset C | |
Sensitivity | Diabetes | 79.2 | 90.4 |
a
|
Hypertension | 67.2 | 60.7 | 33.8 | |
Hypothyroidism | 49.7 | 66.7 | 39.9 | |
Asthma | 0.0 | * | 58.1 | |
Obesity | 11.5 | 65.5 | 14.6 | |
Urinary Tract Infection | 66.7 | * | 62.9 | |
“Consistency of Capture” [46] | Problem List | 71.4 | 57.1 | n/a |
Allergy Record | 48.2 | 46.6 | 11.0 | |
Medications | 69.8 | 60.8 | 83.0 | |
Recording of Blood Pressure, Height, and Weight | Blood Pressure | 89.1b,c | 81.1c | 87.0b,c |
Height | 70.7b,c | 29.3c | 55.3b,c | |
Weight | 78.3b,c | 59.5c | 69.0b,c | |
Recording of Blood Pressure among Patients Requiring a Blood Pressure Measurement | Diabetes Diagnosis | 80.7 | 97.1 |
a
|
Hypertension Medication | 75.7 | 100.0 | 87.7 |
Correctness
Results (%) | ||||
---|---|---|---|---|
Measure | Dataset A | Dataset B | Dataset C | |
Positive Predictive Value | Diabetes | 79.5 | 48.9 |
a
|
Hypertension | 77.9 | 58.7 | 65.8 | |
Hypothyroidism | 60.7 | 37.6 | 76.0 | |
Asthma | 0.0 | * | 16.1 | |
Obesity | 83.5 | 4.0 | 61.8 | |
Urinary Tract Infection | 0.1 | * | 3.5 | |
Unlikely Combinations of Age & Specific Procedures | Tetanus Toxoid Conjugate Vaccination | 0.0 | 0.0 | 0.0 |
Currency
Results (%) | ||||
---|---|---|---|---|
Measure | Dataset A | Dataset B | Dataset C | |
Timeliness of Weight Recording for Patients with Obesity | Weight Recording | 62.0 | 76.4 | 85.5 |
Timeliness of Visit for Pregnancy | Visiting Patients | 14.7 | 50.0 | 62.7 |
Timeliness of Blood Pressure, Height, and Weight Recording | Blood Pressure | 64.4a,b | 93.7b | 82.4a,b |
Height | 30.4a,b | 33.3b | 42.4a,b | |
Weight | 45.2a,b | 61.6b | 57.5a,b |