Published in:
01-12-2019 | Chronic Kidney Disease | Original Research
Electronic Health Record Phenotypes for Identifying Patients with Late-Stage Disease: a Method for Research and Clinical Application
Published in: Journal of General Internal Medicine | Issue 12/2019
Login to get accessABSTRACT
Background
Systematic identification of patients allows researchers and clinicians to test new models of care delivery. EHR phenotypes—structured algorithms based on clinical indicators from EHRs—can aid in such identification.
Objective
To develop EHR phenotypes to identify decedents with stage 4 solid-tumor cancer or stage 4–5 chronic kidney disease (CKD).
Design
We developed two EHR phenotypes. Each phenotype included International Classification of Diseases (ICD)-9 and ICD-10 codes. We used natural language processing (NLP) to further specify stage 4 cancer, and lab values for CKD.
Subjects
Decedents with cancer or CKD who had been admitted to an academic medical center in the last 6 months of life and died August 26, 2017–December 31, 2017.
Main Measure
We calculated positive predictive values (PPV), false discovery rates (FDR), false negative rates (FNR), and sensitivity. Phenotypes were validated by a comparison with manual chart review. We also compared the EHR phenotype results to those admitted to the oncology and nephrology inpatient services.
Key Results
The EHR phenotypes identified 271 decedents with cancer, of whom 186 had stage 4 disease; of 192 decedents with CKD, 89 had stage 4–5 disease. The EHR phenotype for stage 4 cancer had a PPV of 68.6%, FDR of 31.4%, FNR of 0.5%, and 99.5% sensitivity. The EHR phenotype for stage 4–5 CKD had a PPV of 46.4%, FDR of 53.7%, FNR of 0.0%, and 100% sensitivity.
Conclusions
EHR phenotypes efficiently identified patients who died with late-stage cancer or CKD. Future EHR phenotypes can prioritize specificity over sensitivity, and incorporate stratification of high- and low-palliative care need. EHR phenotypes are a promising method for identifying patients for research and clinical purposes, including equitable distribution of specialty palliative care.