A survey of validity and utility of electronic patient records in a general practice
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7299.1401 (Published 09 June 2001) Cite this as: BMJ 2001;322:1401Data supplement
EPR-Val Test Pack Version 2*
*NOTE (2 Aug 2001): The EPR-Val toolkit has been modified to correct an error in the calculation of confidence intervals. We recommend that users upgrade from EPR-Val to EPR-Val Version 2. (You need MS Excel to view this file)
Morbidity validation—diagnostic criteria for the 15 test conditions
The main search for the test conditions was performed against the appropriate Read code(s) for each condition. Triangulation against specific drug and/or treatment codes was performed to validate the diagnosis and calculate the test statistics for each condition
· Breast cancer—High-level Read code for breast cancer, plus all daughter codes and/or mastectomy and/or prescription of any of the following; tamoxifen, aminoglutethimide, anastrozole, formestane, letrozole and toremifene. Also triangulate against Read codes for radiotherapy and/or chemotherapy. 99% of breast cancer occurs in women.
· Prostate cancer—High level Read code for prostate cancer, plus all daughter codes and/or total prostatectomy and/or orchidectomy and/or prescription of any of the following; diethylstilbestrol, bicalutamide, buserelin, cyproterone, flutamide, goserelin, leuprorelin and triptorelin. Also triangulate against Read codes for radiotherapy and/or chemotherapy. Prostate disease occurs only in men.
· Diabetes mellitus—High level Read code for diabetes mellitus, plus all daughter codes and/or complication codes (e.g. diabetic retinopathy, nephropathy, neuropathy) and/or prescription of any of the following drug groups; insulins, biguanides, sulphonylureas, diagnostic, monitoring agents for diabetes, hypodermic equipment, drugs used in the treatment of hypoglycaemia and/or fasting blood sugar >7 mmol/l and/or random blood sugar >11.1 mmol/l.
· Obesity—High level Read code for obesity, plus all daughter codes and/or body mass index >30 kg/m2 and/or prescription of either of the following; orlistat and phentermine.
· Hypothyroidism—High level read code for hypothyroidism and/or goitre, plus all daughter codes and/or prescription of thyroxine and/or serum thyroid stimulating hormone (TSH) >6.9 mIU/l.
· Hyperthyroidism—High level Read code for hyperthyroidism, plus all daughter codes and/or prescription of either of the following; carbimazole and/or propylthiouracil and/or serum thyroxine >25.6 pmol/l. Also triangulate against Read codes for thyroidectomy.
· Gout—High level Read code for gout, plus all daughter codes and/or prescription of any of the following; indomethacin, allopurinol, colchicine, probenecid and sulfinpyrazone and/or serum urate >0.44 mmol/l (male) >0.35 mmol/l (female).
· Iron deficiency anaemia—High level Read code for iron deficiency anaemia, plus all daughter codes and/or prescription of iron preparations and/or serum ferritin <10 ng/ml.
· Glaucoma—High level Read code for glaucoma, plus all daughter codes and/or prescriptions for any of the following eye preparations; carbachol, pilocarpine, adrenaline/epinephrine, brimonidine, dipivefrine, guanethidine, betaxolol, cateolol, levobunolol, metipranolol, timolol, orzolamide and latanoprost.
· Epilepsy—High level Read code for epilepsy, plus all daughter codes and/or prescription of any of the following; carbamazepine, clobazam, clonazepam, diazepam rectal tubes, ethosuximide, lamotrigine, phenobarbital, primidone, phenytoin, topirimate, valproate and vigabatrin.
· Parkinson’s disease—High level Read code for Parkinson’s disease, plus all daughter codes and/or prescription of any of the following; levodopa/decarboxylase preparations, selegiline, entacapone, bromocriptine, cabergomine, lisuride, pergolide, ropinirole, pramipexole, amantadine, apomorphine, orphenadrine, benzhexol, benzatropine and procyclidine.
· Ischaemic heart disease—High level Read code for ischaemic heart disease, plus all daughter codes and/or codes for related diagnoses and treatments (e.g. angina, myocardial infarction, heart failure, coronary artery bypass graft, coronary angiography, coronary angioplasty, aspirin prophylaxis advice, ischaemic heart disease screening) and/or prescription of any of the following drug groups; nitrates, aspirin, statins, calcium channel blockers, ACE inhibitors, loop diuretics and potassium channel activators. This list of drug treatments reflects recent prescribing practice at the FMC and is not an exhaustive list of drug treatments for ischaemic heart disease.
· Hypertension—High level Read code for hypertension, plus all daughter codes and/or blood pressure >150/90 mm Hg (British Hypertension Society 1999) and/or prescription of any of the following; atenolol, labetalol, metoprolol, α adrenoceptor blocking drugs and thiazide diuretics. This list of drug treatments reflects recent prescribing practice at the FMC and is not an exhaustive list of drug treatments for hypertension.
· Asthma—High level Read code for asthma, plus all daughter codes and/or prescription of any of the following drug groups; selective β2 adrenoceptor stimulants, antimuscarinic bronchodilators, theophyllines, inhaled corticosteroids, cromoglycates and leukotriene receptor antagonists, but excluding the diagnosis of chronic obstructive pulmonary disease (COPD).
· Rheumatoid arthritis—High level Read code for rheumatoid arthritis, plus all daughter codes and/or prescription of any of the following drugs; myocrisin, penicillamine, chloroquine, hydroxychloroquine, azothioprine, methotrexate and sulphasalazine and/or seropositive rheumatoid factor.
Contingency tables for the 15 diagnoses
Test condition = breast cancer Test Condition Present Absent Totals Test for condition Present 54 0 54 Read Code + or - Absent 3 13544 13547 Totals 57 13544 13601
Test condition = prostate cancer Test Condition Present Absent Totals Test for condition Present 24 1 25 Read Code + or - Absent 0 13576 13576 Totals 24 13577 13601
Test condition = diabetes mellitus Test Condition Present Absent Totals Test for condition Present 286 2 288 Read Code + or - Absent 5 13300 13305 Totals 291 13302 13593
Test condition = obesity Test Condition Present Absent Totals Test for condition Present 17 2 19 Read Code + or - Absent 794 12789 13583 Totals 811 12791 13602
Test condition = hypothyroidism Test Condition Present Absent Totals Test for condition Present 193 5 198 Read Code + or - Absent 42 13366 13408 Totals 235 13371 13606
Test condition = Hyperthyroidism Test Condition Present Absent Totals Test for condition Present 47 2 49 Read Code + or - Absent 1 13545 13546 Totals 48 13547 13595
Test condition = gout Test Condition Present Absent Totals Test for condition Present 207 5 212 Read Code + or - Absent 14 13379 13393 Totals 221 13384 13605
Test condition = Iron deficiency anaemia Test Condition Present Absent Totals Test for condition Present 149 5 154 Read Code + or - Absent 43 13399 13442 Totals 192 13404 13596
Test condition = Glaucoma Test Condition Present Absent Totals Test for condition Present 107 5 112 Read Code + or - Absent 4 13486 13490 Totals 111 13491 13602
Test condition = Epilepsy Test Condition Present Absent Totals Test for condition Present 79 4 83 Read Code + or - Absent 5 13516 13521 Totals 84 13520 13604
Test condition = Parkinson's disease Test Condition Present Absent Totals Test for condition Present 26 1 27 Read Code + or - Absent 4 13568 13572 Totals 30 13569 13599
Test condition = Ischaemic heart disease Test Condition Present Absent Totals Test for condition Present 681 20 701 Read Code + or - Absent 32 12862 12894 Totals 713 12882 13595
Test condition = Hypertension Test Condition Present Absent Totals Test for condition Present 871 10 881 Read Code + or - Absent 20 12695 12715 Totals 891 12705 13596
Test condition = Asthma Test Condition Present Absent Totals Test for condition Present 630 100 730 Read Code + or - Absent 92 12774 12866 Totals 722 12874 13596
Test condition = Rheumatoid arthritis Test Condition Present Absent Totals Test for condition Present 94 8 102 Read Code + or - Absent 1 13493 13494 Totals 95 13501 13596
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