Abstract
Background: A recent feasibility assessment of quality indicators for nonvalvular atrial fibrillation/atrial flutter (NVAF/AFL) identified the Canadian Primary Care Sentinel Surveillance Network, a national outpatient electronic medical record (EMR) system, as a data source for measurement. As a first step, we adapted and validated an existing EMR case definition. Methods: A diagnosis of NVAF/AFL was defined using International Classification of Disease, 9th Revision, Clinical Modification codes (427.3) in either the physician billing, encounter diagnosis, or health condition fields. We identified all presumed cases in a single clinical site with the algorithm and selected a random sample of those who were presumed NVAF/AFL negative with the same algorithm. A chart audit diagnosis of “definite” NVAF/AFL was confirmed by electrocardiogram and nonvalvular diagnosis confirmed after echocardiogram, attending physician, or specialist letter review. To demonstrate face validity, clinical characteristics were compared for patients with and without NVAF/AFL. Results: The case definition identified a possible 184 patients with and 184 without NVAF/AFL. The case validation resulted in a sensitivity of 100% (95% confidence interval [CI], 100-100), specificity of 84.3% (95% CI, 78.8-89.9), and positive and negative predictive value of 74.7% (95% CI, 66.4-83.2) and 100% (95% CI 100-100), respectively. Patients with NVAF/AFL were older (63 vs 42 years) and had a higher proportion of cardiovascular comorbidities and relevant medications. Conclusions: We think it is possible that with further validation work, NVAF/AFL can be accurately identified using this large pan-Canadian EMR system and used as a future tool to measure quality of care in the outpatient setting.
| Original language | English |
|---|---|
| Pages (from-to) | 367-371 |
| Number of pages | 5 |
| Journal | CJC Open |
| Volume | 3 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Mar 2021 |
Bibliographical note
Funding Information:We would like to thank all members of the CCS AF/AFL QI working group for their contributions to quality improvement activities. We would also like to extend our thanks to Dr Alex Singer and Ms Leanne Kosowan from the Department of Family Medicine, Max Rady College of Medicine, at the University of Manitoba, for their kind SAS programming assistance. This work was supported by Bristol-Myers Squibb/Pfizer (Canada) Alliance Quality Improvement Grant (RKS, ID # 54272805) and discretionary funding from J.L.C. R.K.S. holds research grants from Servier, Canada and Bristol-Myers Squibb/Pfizer, Canada. J.L.C. has grant funding from Bayer, Canada and has received honoraria from Bayer and Daikii. The opinions expressed in this publication are those of the authors/researchers, and do not necessarily reflect the official views of the Canadian Primary Care Sentinel Surveillance Network. The authors retained full academic control of this work including the right to publish.
Funding Information:
R.K.S. holds research grants from Servier, Canada and Bristol-Myers Squibb/Pfizer, Canada. J.L.C. has grant funding from Bayer, Canada and has received honoraria from Bayer and Daikii. The opinions expressed in this publication are those of the authors/researchers, and do not necessarily reflect the official views of the Canadian Primary Care Sentinel Surveillance Network. The authors retained full academic control of this work including the right to publish.
Funding Information:
This work was supported by Bristol-Myers Squibb/Pfizer (Canada) Alliance Quality Improvement Grant (RKS, ID # 54272805) and discretionary funding from J.L.C.
Publisher Copyright:
© 2020 Canadian Cardiovascular Society
ASJC Scopus Subject Areas
- Cardiology and Cardiovascular Medicine
PubMed: MeSH publication types
- Journal Article