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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1049 — An Electronic Health Record-Based Trigger to Detect Potential Delays in Colorectal Cancer Diagnosis

Laxmisan A (Baylor College of Medicine), Parikh RC (Baylor College of Medicine), Reis BA (Baylor College of Medicine), Singh H (Michael E. DeBakey Veterans Affairs Medical Center)

Delays in colorectal (CRC) diagnosis are frequent. We developed an electronic health record (EHR)-based methodology using triggers (i.e., signals that prompt record review) to identify patients at risk for delayed CRC diagnosis.

On the basis of extensive pilot-work, literature review and subject matter input, we developed two electronic queries that used a sequential algorithm to “trigger” patients at risk of delayed CRC diagnosis. Risk was defined as lack of colonoscopy performance within 60 days of certain pre-defined clinical clues for CRC diagnosis. The two queries were applied to the EHR data repository of a tertiary care VA facility to identify an initial test cohort of patients with Iron Deficiency Anemia (IDA) or positive Fecal Occult Blood Testing (FOBT). IDA was defined as patients with a hemoglobin value < = 11 g/dl and mean corpuscular volume < = 81 fl and no recorded ferritin > = 100 ng/dl 12 months before or 60 days after hemoglobin date. FOBT was considered positive if any one of three FOBT cards was positive. We iteratively refined the queries based on additional clinical criteria, for example, we excluded patients receiving palliative care from being triggered. The final queries were applied to all patients seen at the facility between March 1, 2009 and March 1, 2010. We randomly selected 120 subjects and used a standardized pre-tested data collection instrument to assess if the subjects were at risk, i.e. true trigger positive.

Of 89,187 patients to whom the trigger was applied, we identified 258 (0.3%) IDA patients and 337(0.4%) FOBT positive patients at risk. Of 120 patients reviewed, 90 were true trigger positives (PPV of trigger = 75%). Most common reason for false positive trigger was colonoscopies performed privately.

EHR-based triggger methods are potentially useful to detect potential delays in CRC diagnosis and have a PPV superior to other methods of detection of diagnostic delays. Moreover, it is more efficient than review of a large number of IDA and positive FOBT records to identify potential delays.

Our methodology can be used by VA facilities to proactively identify delays of CRC diagnosis.

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