External validation of EPICON: a grouping system for estimating morbidity rates using electronic medical records.

Department of Medical Informatics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
Journal of the American Medical Informatics Association (Impact Factor: 3.93). 09/2008; 15(6):770-5. DOI: 10.1197/jamia.M2774
Source: DBLP

ABSTRACT To externally validate EPICON, a computerized system for grouping diagnoses from EMRs in general practice into episodes of care. These episodes can be used for estimating morbidity rates.
Comparative observational study.
Morbidity rates from an independent dataset, based on episode-oriented EMRs, were used as the gold standard. The EMRs in this dataset contained diagnoses which were manually grouped by GPs. The authors ungrouped these diagnoses and regrouped them automatically into episodes using EPICON. The authors then used these episodes to estimate morbidity rates that were compared to the gold standard. The differences between the two sets of morbidity rates were calculated and the authors analyzed large as well as structural differences to establish possible causes.
In general, the morbidity rates based on EPICON deviate only slightly from the gold standard. Out of 675 diagnoses, 36 (5%) were considered to be deviating diagnoses. The deviating diagnoses showed differences for two main reasons: "differences in rules between the two methods of episode construction" and "inadequate performance of EPICON."
The EPICON system performs well for the large majority of the morbidity rates. We can therefore conclude that EPICON is useful for grouping episodes to estimate morbidity rates using EMRs from general practices. Morbidity rates of diseases with a broad range of symptoms should, however, be interpreted cautiously.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Joling KJ, Van Hout HP, Schellevis FG, Van der Horst HE, Scheltens P, Knol DL, Van Marwijk HW. Depressie en angst bij partners van dementiepatiënten. Huisarts Wet 2010;53(7):420-4. Achtergrond Zorgen voor iemand met dementie kan gepaard gaan met depressiviteit en angst. Er is echter weinig bekend over de incidentie van de depressie en angst bij partners van patiënten met dementie. Wij hebben een schatting gemaakt op basis van gegevens uit het Landelijk Informatie Netwerk Huisartsenzorg (LINH). Methode In een prospectief naturalistisch cohortonderzoek hebben we 218 personen met een dementerende partner vergeleken met 353 personen van vergelijkbare leeftijd en geslacht met een partner zónder dementie. De gegevens kwamen uit LINH-registraties van 2001 tot 2007. De belangrijkste uitkomstmaten waren de incidentie en de hazard ratio (per duizend persoonsjaren) van depressie en angst. Resultaten Partners van mensen met dementie hadden ruim viermaal zoveel kans dat hun huisarts de diagnose depressie stelde als personen zonder dementerende partner. In een jaar tijd registreerden huisartsen een nieuwe depressie bij 18,8 per duizend personen met een dementerende partner, en bij 4 per duizend personen zonder dementerende partner. Ook schreef de huisarts significant vaker antidepressiva en anxiolytica voor aan mensen met een dementerende partner. Conclusie Mensen met een dementerende partner hebben een verhoogd risico op een diagnose depressie in vergelijking met personen zonder demente partner. Voor angst vonden we geen significant verschil tussen beide groepen. angst-dementie-depressie-onderzoek
    Huisarts en wetenschap 01/2010; 53(8):420-424.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous research on time to referral to orthopaedic surgery has predominantly used hip complaints as starting point instead of the moment the diagnosis of osteoarthritis (OA) of the hip is established, therefore little is known about the length of time a patient diagnosed with hip OA stays under the care of a general practitioner (GP). No knowledge on factors of influence on this time period is available either. Aim of this study was thus to determine the time an incident hip OA patient stays in the care of a GP until referral to an orthopaedic department. Influencing factors were also analyzed. A prospective observational study was conducted based on data over a 10-year period from a general practice-based registration network (17 GPs, > 30,000 patients registered yearly). Patients with the diagnosis of hip OA were included. A survival analysis was used to determine time until referral to an orthopaedic department, and to determine factors of influence on this time. Of 391 patients diagnosed with hip OA, 121 (31%) were referred; average survival time until referral was 82.0 months (95% CI 76.6-87.5). Less contact with the GP for hip complaints before the diagnosis of hip OA was established resulted in a decreased time to referral. The results of this study show that patients with hip OA were under the care of a general practitioner, and thus in primary care, for a considerable amount of time once the diagnosis of hip OA was established.
    BMC Family Practice 01/2011; 12:48. · 1.74 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Earlier research showed that healthcare in stroke could be better organized, aiming for improved survival and less comorbidity. Therefore, in 2004 the Dutch College of General Practitioners (NHG) and the Dutch Association of Neurology (NVN) introduced the 'Dutch Transmural Protocol TIA/CVA' (the LTA) to improve survival, minimize the risk of stroke recurrence, and increase quality of life after stroke. This study examines whether survival improved after implementation of the new protocol, and whether there was an increase in contacts with the general practitioner (GP)/nurse practitioner, registration of comorbidity and prescription of medication. METHODS: From the primary care database of the Registration Network Groningen (RNG) two cohorts were composed: one cohort compiled before and one after introduction of the LTA. Cohort 1 (n = 131, first stroke 2001--2002) was compared with cohort 2 (n = 132, first stroke 2005--2006) with regard to survival and the secondary outcomes. RESULTS: Comparison of the two cohorts showed no significant improvement in survival. In cohort 2, the number of contacts with the GP was significantly lower and with the nurse practitioner significantly higher, compared with cohort 1. All risk factors for stroke were more prevalent in cohort 2, but were only significant for hypercholesterolemia. In both cohorts more medication was prescribed after stroke, whereas ACE inhibitors were prescribed more frequently only in cohort 2. CONCLUSION: No major changes in survival and secondary outcomes were apparent after introduction of the LTA. Although, there was a small improvement in secondary prevention, this study shows that optimal treatment after introduction of the LTA has not yet been achieved.
    BMC Family Practice 06/2013; 14(1):74. · 1.74 Impact Factor

Full-text (2 Sources)

Available from
May 29, 2014