- Clin Med Res
- v.11(3); Sep 2013
- PMC3788482
Clin Med Res. 2013 September; 11(3): 143.
PMCID: PMC3788482
PS1-1a: Use of the CER Hub to Identify Out-of-Control Asthma and Compare Therapeutic Classes of Step-Up Asthma Medications in Clinical Practice
ABSTRACT
Background/Aims
Asthma is a chronic inflammatory condition that imposes a substantial burden on patients and society. A major target in asthma care is guideline adherence to disease control assessment and therapy. Our aim was to develop an electronic medical record (EMR) based measure of provider determination of asthma control and use it to assess different treatment modalities employed in out-of-control asthma to allow observational comparative effectiveness research (CER) on different types of step-up therapy.
Methods
We developed EMR-based abstraction rules to allow automated determination of asthma control during clinical encounters, a construct that indicates need for treatment intensification. The EMR-based measure operationalizes components in the Expert Panel Report-3 recommendations for assessing a patient’s level of asthma control across the domains of risk and impairment. We used manual chart abstraction on samples of encounter records provided by six diverse health systems participating in the CER Hub project, to develop and validate the EMR-based measure of asthma control.
Results
We identified over 185,000 patients diagnosed with asthma across CER-Hub during 2006–2010. Provider documentation (predominantly text clinical notes) was rich in data related to asthma control including aspects of impairment (patient-reported symptom frequency, nighttime awakenings, interference with activity, frequency of rescue inhaler use, and lung function) and risk to patient well-being such as asthma exacerbations and use of systemic corticosteroids. Using the automated medical record classifier MediClass, which enables access to both coded and free-text components of the record, we will assess patients on low-dose inhaled corticosteroid therapy whose asthma is not well controlled. We are using the EMR-based measure to investigate the comparative effectiveness of the following step-up therapies (1) addition of a leukotriene modifier, (2) addition of a long-acting beta-agonist, and (3) increase to higher dose inhaled corticosteroids.
Conclusions
Traditional large database studies have been unable to assess elements of asthma control, such as symptom frequencies or activity limitations, because these clinical data are typically only available within free-text progress notes documenting the patient visit. The CER Hub asthma control measure provides new capacity to evaluate the comparative effectiveness of asthma interventions across diverse healthcare settings and in large real-world populations.
Keywords: Assessing Provider Behavior, Asthma, Asthma Control Assessment
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Articles from Clinical Medicine & Research are provided here courtesy of Marshfield Clinic
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