Identifying Cases of Type 2 Diabetes in Heterogeneous Data Sources: Strategy from the EMIF Project
Due to the heterogeneity of existing European sources of observational healthcare data, data source-tailored choices are needed to execute multi-data source, multi-national epidemiological studies. This makes transparent documentation paramount. In this proof-of-concept study, a novel standard data...
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Published in | PloS one Vol. 11; no. 8; p. e0160648 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
Public Library of Science
31.08.2016
Public Library of Science (PLoS) |
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Abstract | Due to the heterogeneity of existing European sources of observational healthcare data, data source-tailored choices are needed to execute multi-data source, multi-national epidemiological studies. This makes transparent documentation paramount. In this proof-of-concept study, a novel standard data derivation procedure was tested in a set of heterogeneous data sources. Identification of subjects with type 2 diabetes (T2DM) was the test case. We included three primary care data sources (PCDs), three record linkage of administrative and/or registry data sources (RLDs), one hospital and one biobank. Overall, data from 12 million subjects from six European countries were extracted. Based on a shared event definition, sixteeen standard algorithms (components) useful to identify T2DM cases were generated through a top-down/bottom-up iterative approach. Each component was based on one single data domain among diagnoses, drugs, diagnostic test utilization and laboratory results. Diagnoses-based components were subclassified considering the healthcare setting (primary, secondary, inpatient care). The Unified Medical Language System was used for semantic harmonization within data domains. Individual components were extracted and proportion of population identified was compared across data sources. Drug-based components performed similarly in RLDs and PCDs, unlike diagnoses-based components. Using components as building blocks, logical combinations with AND, OR, AND NOT were tested and local experts recommended their preferred data source-tailored combination. The population identified per data sources by resulting algorithms varied from 3.5% to 15.7%, however, age-specific results were fairly comparable. The impact of individual components was assessed: diagnoses-based components identified the majority of cases in PCDs (93-100%), while drug-based components were the main contributors in RLDs (81-100%). The proposed data derivation procedure allowed the generation of data source-tailored case-finding algorithms in a standardized fashion, facilitated transparent documentation of the process and benchmarking of data sources, and provided bases for interpretation of possible inter-data source inconsistency of findings in future studies. |
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AbstractList | Due to the heterogeneity of existing European sources of observational healthcare data, data source-tailored choices are needed to execute multi-data source, multi-national epidemiological studies. This makes transparent documentation paramount. In this proof-of-concept study, a novel standard data derivation procedure was tested in a set of heterogeneous data sources. Identification of subjects with type 2 diabetes (T2DM) was the test case. We included three primary care data sources (PCDs), three record linkage of administrative and/or registry data sources (RLDs), one hospital and one biobank. Overall, data from 12 million subjects from six European countries were extracted. Based on a shared event definition, sixteeen standard algorithms (components) useful to identify T2DM cases were generated through a top-down/bottom-up iterative approach. Each component was based on one single data domain among diagnoses, drugs, diagnostic test utilization and laboratory results. Diagnoses-based components were subclassified considering the healthcare setting (primary, secondary, inpatient care). The Unified Medical Language System was used for semantic harmonization within data domains. Individual components were extracted and proportion of population identified was compared across data sources. Drug-based components performed similarly in RLDs and PCDs, unlike diagnoses-based components. Using components as building blocks, logical combinations with AND, OR, AND NOT were tested and local experts recommended their preferred data source-tailored combination. The population identified per data sources by resulting algorithms varied from 3.5% to 15.7%, however, age-specific results were fairly comparable. The impact of individual components was assessed: diagnoses-based components identified the majority of cases in PCDs (93-100%), while drug-based components were the main contributors in RLDs (81-100%). The proposed data derivation procedure allowed the generation of data source-tailored case-finding algorithms in a standardized fashion, facilitated transparent documentation of the process and benchmarking of data sources, and provided bases for interpretation of possible inter-data source inconsistency of findings in future studies. Due to the heterogeneity of existing European sources of observational healthcare data, data source-tailored choices are needed to execute multi-data source, multi-national epidemiological studies. This makes transparent documentation paramount. In this proof-of-concept study, a novel standard data derivation procedure was tested in a set of heterogeneous data sources. Identification of subjects with type 2 diabetes (T2DM) was the test case. We included three primary care data sources (PCDs), three record linkage of administrative and/or registry data sources (RLDs), one hospital and one biobank. Overall, data from 12 million subjects from six European countries were extracted. Based on a shared event definition, sixteeen standard algorithms (components) useful to identify T2DM cases were generated through a top-down/bottom-up iterative approach. Each component was based on one single data domain among diagnoses, drugs, diagnostic test utilization and laboratory results. Diagnoses-based components were subclassified considering the healthcare setting (primary, secondary, inpatient care). The Unified Medical Language System was used for semantic harmonization within data domains. Individual components were extracted and proportion of population identified was compared across data sources. Drug-based components performed similarly in RLDs and PCDs, unlike diagnoses-based components. Using components as building blocks, logical combinations with AND, OR, AND NOT were tested and local experts recommended their preferred data source-tailored combination. The population identified per data sources by resulting algorithms varied from 3.5% to 15.7%, however, age-specific results were fairly comparable. The impact of individual components was assessed: diagnoses-based components identified the majority of cases in PCDs (93-100%), while drug-based components were the main contributors in RLDs (81-100%). The proposed data derivation procedure allowed the generation of data source-tailored case-finding algorithms in a standardized fashion, facilitated transparent documentation of the process and benchmarking of data sources, and provided bases for interpretation of possible inter-data source inconsistency of findings in future studies. The research leading to these results has received support from the Innovative Medicines Initiative Joint Undertaking (http://www.imi.europa.eu/) under European Medical Information Framework grant agreement no. 115372, resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and European Federation of Pharmaceutical Industries and Association companies’ in kind contribution. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Pfizer Worldwide Research and Development, GlaxoSmithKline, Cegedim Strategic Data Medical Research Ltd and Janssen provided support in the form of salaries for AKL, PE, DA and MJS, respectively, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section. Due to the heterogeneity of existing European sources of observational healthcare data, data source-tailored choices are needed to execute multi-data source, multi-national epidemiological studies. This makes transparent documentation paramount. In this proof-of-concept study, a novel standard data derivation procedure was tested in a set of heterogeneous data sources. Identification of subjects with type 2 diabetes (T2DM) was the test case. We included three primary care data sources (PCDs), three record linkage of administrative and/or registry data sources (RLDs), one hospital and one biobank. Overall, data from 12 million subjects from six European countries were extracted. Based on a shared event definition, sixteeen standard algorithms ( components) useful to identify T2DM cases were generated through a top-down/bottom-up iterative approach. Each component was based on one single data domain among diagnoses, drugs, diagnostic test utilization and laboratory results. Diagnoses-based components were subclassified considering the healthcare setting (primary, secondary, inpatient care). The Unified Medical Language System was used for semantic harmonization within data domains. Individual components were extracted and proportion of population identified was compared across data sources. Drug-based components performed similarly in RLDs and PCDs, unlike diagnoses-based components. Using components as building blocks, logical combinations with AND, OR, AND NOT were tested and local experts recommended their preferred data source-tailored combination. The population identified per data sources by resulting algorithms varied from 3.5% to 15.7%, however, age-specific results were fairly comparable. The impact of individual components was assessed: diagnoses-based components identified the majority of cases in PCDs (93–100%), while drug-based components were the main contributors in RLDs (81–100%). The proposed data derivation procedure allowed the generation of data source-tailored case-finding algorithms in a standardized fashion, facilitated transparent documentation of the process and benchmarking of data sources, and provided bases for interpretation of possible inter-data source inconsistency of findings in future studies. Due to the heterogeneity of existing European sources of observational healthcare data, data source-tailored choices are needed to execute multi-data source, multi-national epidemiological studies. This makes transparent documentation paramount. In this proof-of-concept study, a novel standard data derivation procedure was tested in a set of heterogeneous data sources. Identification of subjects with type 2 diabetes (T2DM) was the test case. We included three primary care data sources (PCDs), three record linkage of administrative and/or registry data sources (RLDs), one hospital and one biobank. Overall, data from 12 million subjects from six European countries were extracted. Based on a shared event definition, sixteeen standard algorithms (components) useful to identify T2DM cases were generated through a top-down/bottom-up iterative approach. Each component was based on one single data domain among diagnoses, drugs, diagnostic test utilization and laboratory results. Diagnoses-based components were subclassified considering the healthcare setting (primary, secondary, inpatient care). The Unified Medical Language System was used for semantic harmonization within data domains. Individual components were extracted and proportion of population identified was compared across data sources. Drug-based components performed similarly in RLDs and PCDs, unlike diagnoses-based components. Using components as building blocks, logical combinations with AND, OR, AND NOT were tested and local experts recommended their preferred data source-tailored combination. The population identified per data sources by resulting algorithms varied from 3.5% to 15.7%, however, age-specific results were fairly comparable. The impact of individual components was assessed: diagnoses-based components identified the majority of cases in PCDs (93-100%), while drug-based components were the main contributors in RLDs (81-100%). The proposed data derivation procedure allowed the generation of data source-tailored case-finding algorithms in a standardized fashion, facilitated transparent documentation of the process and benchmarking of data sources, and provided bases for interpretation of possible inter-data source inconsistency of findings in future studies.Due to the heterogeneity of existing European sources of observational healthcare data, data source-tailored choices are needed to execute multi-data source, multi-national epidemiological studies. This makes transparent documentation paramount. In this proof-of-concept study, a novel standard data derivation procedure was tested in a set of heterogeneous data sources. Identification of subjects with type 2 diabetes (T2DM) was the test case. We included three primary care data sources (PCDs), three record linkage of administrative and/or registry data sources (RLDs), one hospital and one biobank. Overall, data from 12 million subjects from six European countries were extracted. Based on a shared event definition, sixteeen standard algorithms (components) useful to identify T2DM cases were generated through a top-down/bottom-up iterative approach. Each component was based on one single data domain among diagnoses, drugs, diagnostic test utilization and laboratory results. Diagnoses-based components were subclassified considering the healthcare setting (primary, secondary, inpatient care). The Unified Medical Language System was used for semantic harmonization within data domains. Individual components were extracted and proportion of population identified was compared across data sources. Drug-based components performed similarly in RLDs and PCDs, unlike diagnoses-based components. Using components as building blocks, logical combinations with AND, OR, AND NOT were tested and local experts recommended their preferred data source-tailored combination. The population identified per data sources by resulting algorithms varied from 3.5% to 15.7%, however, age-specific results were fairly comparable. The impact of individual components was assessed: diagnoses-based components identified the majority of cases in PCDs (93-100%), while drug-based components were the main contributors in RLDs (81-100%). The proposed data derivation procedure allowed the generation of data source-tailored case-finding algorithms in a standardized fashion, facilitated transparent documentation of the process and benchmarking of data sources, and provided bases for interpretation of possible inter-data source inconsistency of findings in future studies. |
Audience | Academic |
Author | Coloma, Preciosa Sturkenboom, Miriam van der Lei, Johan Roberto, Giuseppe Gini, Rosa Herings, Ron Tammesoo, Mari-Liis van Wijngaarden, Rients Ansell, David Loomis, A. Katrina Lapi, Francesco Rijnbeek, Peter Sattar, Naveed Pasqua, Alessandro Mayer, Miguel A. Alavere, Helene Cunningham, James Tramontan, Lara Reisberg, Sulev Schuemie, Martijn J. Leal, Ingrid Pedersen, Lars Egger, Peter Avillach, Paul |
AuthorAffiliation | 16 Hospital del Mar Medical Research Institute (IMIM) and Universitat Pompeu Fabra, Barcelona, Spain 2 Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands 6 GlaxoSmithKline, Worldwide Epidemiology GSK, Stockley Park West, Uxbridge, United Kingdom 8 The Health Improvement Network, Cegedim Strategic Data Medical Research Ltd, London, United Kingdom 10 Estonian Genome Center, University of Tartu, Tartu, Estonia 12 Health Search, Italian College of General Practitioners and Primary Care, Firenze, Italy 1 Regional Agency for Healthcare Services of Tuscany, Epidemiology unit, Florence, Italy 5 Department of Biomedical Informatics, Harvard Medical School & Children’s Hospital Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, United States of America 14 University of Manchester, Manchester, United Kingdom 3 British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom 4 Pfizer Worldwide Resea |
AuthorAffiliation_xml | – name: 3 British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom – name: 1 Regional Agency for Healthcare Services of Tuscany, Epidemiology unit, Florence, Italy – name: 13 Department of Clinical Epidemiology, Aarhus University Hosptial, Aarhus, Denmark – name: 2 Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands – name: 9 Quretec, Software Technology and Applications Competence Center, University of Tartu, Tartu, Estonia – name: 12 Health Search, Italian College of General Practitioners and Primary Care, Firenze, Italy – name: 7 PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands – name: 16 Hospital del Mar Medical Research Institute (IMIM) and Universitat Pompeu Fabra, Barcelona, Spain – name: 10 Estonian Genome Center, University of Tartu, Tartu, Estonia – name: 18 Observational Health Data Sciences and Informatics, New York, New York, United States of America – name: 6 GlaxoSmithKline, Worldwide Epidemiology GSK, Stockley Park West, Uxbridge, United Kingdom – name: 8 The Health Improvement Network, Cegedim Strategic Data Medical Research Ltd, London, United Kingdom – name: 11 Tartu University Hospital, Tartu, Estonia – name: 4 Pfizer Worldwide Research and Development, Groton, Connecticut, United States of America – name: 17 Janssen Research & Development, Epidemiology, Titusville, New Jersey, United States of America – name: 14 University of Manchester, Manchester, United Kingdom – name: 5 Department of Biomedical Informatics, Harvard Medical School & Children’s Hospital Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, United States of America – name: 15 Arsenàl.IT Consortium, Veneto's Research Centre for eHealth Innovation, Treviso, Italy – name: Universita degli Studi di Firenze, ITALY |
Author_xml | – sequence: 1 givenname: Giuseppe orcidid: 0000-0001-6478-6442 surname: Roberto fullname: Roberto, Giuseppe – sequence: 2 givenname: Ingrid surname: Leal fullname: Leal, Ingrid – sequence: 3 givenname: Naveed surname: Sattar fullname: Sattar, Naveed – sequence: 4 givenname: A. Katrina surname: Loomis fullname: Loomis, A. Katrina – sequence: 5 givenname: Paul surname: Avillach fullname: Avillach, Paul – sequence: 6 givenname: Peter surname: Egger fullname: Egger, Peter – sequence: 7 givenname: Rients surname: van Wijngaarden fullname: van Wijngaarden, Rients – sequence: 8 givenname: David surname: Ansell fullname: Ansell, David – sequence: 9 givenname: Sulev surname: Reisberg fullname: Reisberg, Sulev – sequence: 10 givenname: Mari-Liis surname: Tammesoo fullname: Tammesoo, Mari-Liis – sequence: 11 givenname: Helene surname: Alavere fullname: Alavere, Helene – sequence: 12 givenname: Alessandro surname: Pasqua fullname: Pasqua, Alessandro – sequence: 13 givenname: Lars surname: Pedersen fullname: Pedersen, Lars – sequence: 14 givenname: James surname: Cunningham fullname: Cunningham, James – sequence: 15 givenname: Lara surname: Tramontan fullname: Tramontan, Lara – sequence: 16 givenname: Miguel A. surname: Mayer fullname: Mayer, Miguel A. – sequence: 17 givenname: Ron surname: Herings fullname: Herings, Ron – sequence: 18 givenname: Preciosa surname: Coloma fullname: Coloma, Preciosa – sequence: 19 givenname: Francesco surname: Lapi fullname: Lapi, Francesco – sequence: 20 givenname: Miriam surname: Sturkenboom fullname: Sturkenboom, Miriam – sequence: 21 givenname: Johan surname: van der Lei fullname: van der Lei, Johan – sequence: 22 givenname: Martijn J. surname: Schuemie fullname: Schuemie, Martijn J. – sequence: 23 givenname: Peter surname: Rijnbeek fullname: Rijnbeek, Peter – sequence: 24 givenname: Rosa surname: Gini fullname: Gini, Rosa |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/27580049$$D View this record in MEDLINE/PubMed |
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Copyright | COPYRIGHT 2016 Public Library of Science 2016 Roberto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2016 Roberto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. https://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess 2016 Roberto et al 2016 Roberto et al |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Conceptualization: RG GR IL PR MJS. Data curation: GR RG PR. Formal analysis: RG GR. Investigation: RG IL PA RvW DA SR AP LP LT MAM PC PR. Methodology: RG GR IL PR. Software: RG PR. Supervision: RG. Visualization: GR RG. Writing – original draft: GR RG IL. Writing – review & editing: GR IL NS AKL PA PE RvW DA SR M-LT HA AP LP JC LT MAM RH PC FL MS JvdL MJS PR RG. Competing Interests: The authors AKL, PE, DA and MJS are employed by Pfizer, GlaxoSmithKline, Cegedim and Janssen that are commercial companies. However, this did not have any influence on the reporting or discussion of the results presented in this manuscript and does not alter our adherence to PLOS ONE policies on sharing data and materials. |
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SubjectTerms | Age Algorithms Biology and Life Sciences Building components Causes of Chronic illnesses Collaboration Data Mining - methods Data sources Databases, Factual Derivation Diabetes Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - epidemiology Diabetis Diagnostic systems Documentation Drugs Electronic health records Epidemiology Europe - epidemiology Female Genomes Health care Health informatics Heart Heterogeneity Hospitals Humans Information systems Male Medical diagnosis Medical informatics Medical records Medical research Medical screening Medicine and Health Sciences Mortality Physical Sciences Physicians Primary care Protocols clínics Research and Analysis Methods Source studies Standard data Type 2 diabetes |
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