A survey of validity and utility of electronic patient records in a general practice -- Hassey et al. 322 (7299): 1401 Data Supplement

Morbidity validation

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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, a 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 b₂ 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