TY - JOUR
T1 - Clinical code usage in UK general practice:
T2 - a cohort study exploring 18 conditions over 14 years
AU - Zghebi BPharm, MPhil, PhD, Salwa S
AU - Reeves, David
AU - Grigoroglou, Christos
AU - McMillan, Brian
AU - Ashcroft, Darren
AU - Parisi, Rosa
AU - Kontopantelis, Evan
N1 - Funding Information:
This study is funded by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (grant number 211). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Funding Information:
DMA reports research grants from Abbvie, Almirall, Celgene, Eli Lilly, Novartis, UCB and the Leo Foundation.
Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/7/25
Y1 - 2022/7/25
N2 - Objective To assess the diagnostic Read code usage for 18 conditions by examining their frequency and diversity in UK primary care between 2000 and 2013. Design Population-based cohort study Setting 684 UK general practices contributing data to the Clinical Practice Research Datalink (CPRD) GOLD. Participants Patients with clinical codes for at least one of asthma, chronic obstructive pulmonary disease, diabetes, hypertension (HT), coronary heart disease, atrial fibrillation (AF), heart failure, stroke, hypothyroidism, chronic kidney disease, learning disability (LD), depression, dementia, epilepsy, severe mental illness (SMI), osteoarthritis, osteoporosis and cancer. Primary and secondary outcome measures For the frequency ranking of clinical codes, canonical correlation analysis was applied to correlations of clinical code usage of 1, 3 and 5 years. Three measures of diversity (Shannon entropy index of diversity, richness and evenness) were used to quantify changes in incident and total clinical codes. Results Overall, all examined conditions, except LD, showed positive monotonic correlation. HT, hypothyroidism, osteoarthritis and SMI codes' usage had high 5-year correlation. The codes' usage diversity remained stable overall throughout the study period. Cancer, diabetes and SMI had the highest richness (code lists need time to define) unlike AF, hypothyroidism and LD. SMI (high richness) and hypothyroidism (low richness) can last for 5 years, whereas cancer and diabetes (high richness) and LD (low richness) only last for 2 years. Conclusions This is an under-reported research area and the findings suggest the codes' usage diversity for most conditions remained overall stable throughout the study period. Generated mental health code lists can last for a long time unlike cardiometabolic conditions and cancer. Adopting more consistent and less diverse coding would help improve data quality in primary care. Future research is needed following the transfer to the Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) coding.
AB - Objective To assess the diagnostic Read code usage for 18 conditions by examining their frequency and diversity in UK primary care between 2000 and 2013. Design Population-based cohort study Setting 684 UK general practices contributing data to the Clinical Practice Research Datalink (CPRD) GOLD. Participants Patients with clinical codes for at least one of asthma, chronic obstructive pulmonary disease, diabetes, hypertension (HT), coronary heart disease, atrial fibrillation (AF), heart failure, stroke, hypothyroidism, chronic kidney disease, learning disability (LD), depression, dementia, epilepsy, severe mental illness (SMI), osteoarthritis, osteoporosis and cancer. Primary and secondary outcome measures For the frequency ranking of clinical codes, canonical correlation analysis was applied to correlations of clinical code usage of 1, 3 and 5 years. Three measures of diversity (Shannon entropy index of diversity, richness and evenness) were used to quantify changes in incident and total clinical codes. Results Overall, all examined conditions, except LD, showed positive monotonic correlation. HT, hypothyroidism, osteoarthritis and SMI codes' usage had high 5-year correlation. The codes' usage diversity remained stable overall throughout the study period. Cancer, diabetes and SMI had the highest richness (code lists need time to define) unlike AF, hypothyroidism and LD. SMI (high richness) and hypothyroidism (low richness) can last for 5 years, whereas cancer and diabetes (high richness) and LD (low richness) only last for 2 years. Conclusions This is an under-reported research area and the findings suggest the codes' usage diversity for most conditions remained overall stable throughout the study period. Generated mental health code lists can last for a long time unlike cardiometabolic conditions and cancer. Adopting more consistent and less diverse coding would help improve data quality in primary care. Future research is needed following the transfer to the Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT) coding.
KW - Primary Care
KW - Clinical Codes
KW - Electronic Health Records
KW - QOF
KW - Quality and Outcomes Framework (QOF)
KW - Humans
KW - Hypothyroidism/epidemiology
KW - Diabetes Mellitus
KW - United Kingdom/epidemiology
KW - General Practice
KW - Primary Health Care
KW - Osteoarthritis
KW - Neoplasms/epidemiology
KW - Cohort Studies
U2 - 10.1136/bmjopen-2021-051456
DO - 10.1136/bmjopen-2021-051456
M3 - Article
C2 - 35879012
SN - 2044-6055
VL - 12
JO - BMJ Open
JF - BMJ Open
IS - 7
M1 - e051456
ER -
