20
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Routine primary care data for scientific research, quality of care programs and educational purposes: the Julius General Practitioners’ Network (JGPN)

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          General Practitioners (GPs) in the Netherlands routinely register all patient contacts electronically. These records include longitudinally gathered clinical information of the patient contacts in coded data and free text.

          Methods

          Diagnoses are coded according to the International Coding of Primary Care (ICPC). Drug prescriptions are labelled with the Anatomical Therapeutic Chemical Classification (ATC), and letters of hospital specialists and paramedic health care professionals are linked or directly incorporated in the electronic medical files. A network of a large group of GPs collecting routine care data on an ongoing basis can be used for answering various research questions.

          Results

          The Julius General Practitioners’ Network (JGPN) database consists of routine care data from over ten years of a dynamic cohort of around 370,000 individuals registered with the participating GPs from the city of Utrecht and its vicinity. Health care data are extracted anonymously every quartile of a year and these data are used by researchers.

          Conclusion

          We describe the content and usability of our JGPN database, and how a wide variety of research questions could be answered, as illustrated with examples of published articles.

          Related collections

          Most cited references30

          • Record: found
          • Abstract: found
          • Article: not found

          Definition, structure, content, use and impacts of electronic health records: a review of the research literature.

          This paper reviews the research literature on electronic health record (EHR) systems. The aim is to find out (1) how electronic health records are defined, (2) how the structure of these records is described, (3) in what contexts EHRs are used, (4) who has access to EHRs, (5) which data components of the EHRs are used and studied, (6) what is the purpose of research in this field, (7) what methods of data collection have been used in the studies reviewed and (8) what are the results of these studies. A systematic review was carried out of the research dealing with the content of EHRs. A literature search was conducted on four electronic databases: Pubmed/Medline, Cinalh, Eval and Cochrane. The concept of EHR comprised a wide range of information systems, from files compiled in single departments to longitudinal collections of patient data. Only very few papers offered descriptions of the structure of EHRs or the terminologies used. EHRs were used in primary, secondary and tertiary care. Data were recorded in EHRs by different groups of health care professionals. Secretarial staff also recorded data from dictation or nurses' or physicians' manual notes. Some information was also recorded by patients themselves; this information is validated by physicians. It is important that the needs and requirements of different users are taken into account in the future development of information systems. Several data components were documented in EHRs: daily charting, medication administration, physical assessment, admission nursing note, nursing care plan, referral, present complaint (e.g. symptoms), past medical history, life style, physical examination, diagnoses, tests, procedures, treatment, medication, discharge, history, diaries, problems, findings and immunization. In the future it will be necessary to incorporate different kinds of standardized instruments, electronic interviews and nursing documentation systems in EHR systems. The aspects of information quality most often explored in the studies reviewed were the completeness and accuracy of different data components. It has been shown in several studies that the use of an information system was conducive to more complete and accurate documentation by health care professionals. The quality of information is particularly important in patient care, but EHRs also provide important information for secondary purposes, such as health policy planning. Studies focusing on the content of EHRs are needed, especially studies of nursing documentation or patient self-documentation. One future research area is to compare the documentation of different health care professionals with the core information about EHRs which has been determined in national health projects. The challenge for ongoing national health record projects around the world is to take into account all the different types of EHRs and the needs and requirements of different health care professionals and consumers in the development of EHRs. A further challenge is the use of international terminologies in order to achieve semantic interoperability.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Quality of morbidity coding in general practice computerized medical records: a systematic review.

            Increased use of computers and morbidity coding in primary care delivery and research brings a need for evidence of the quality of general practice medical records. Our aim was to assess the quality, in terms of completeness and correctness, of morbidity coding in computerized general practice records through a systematic review. Published studies were identified by searches of electronic databases and citations of collected papers. Assessment of each article was made by two independent observers and discrepancies resolved by consensus. Studies were reviewed qualitatively due to their heterogeneity. Twenty-four studies met the inclusion criteria for the review. There was variation in the methodology and quality of studies, and problems in generalizability. Studies have attempted to assess the completeness and correctness of morbidity registers by reference to a gold standard such as paper notes, prescribing information or diagnostic tests and procedures, each of which has problems. A consistent finding was that quality of recording varied between morbidities. One reason for this may be in distinctiveness of diagnosis (e.g. coding of diabetes tended to be of higher quality than coding of asthma). This review highlights the problems faced in assessing the completeness and correctness of computerized general practice medical records. However, it also suggests that a high quality of coding can be achieved. The focus should now be on methods to encourage and help practices improve the quality of their coding.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Prediction of adverse health outcomes in older people using a frailty index based on routine primary care data.

              A general frailty indicator could guide general practitioners (GPs) in directing their care efforts to the patients at highest risk. We investigated if a Frailty Index (FI) based on the routine health care data of GPs can predict the risk of adverse health outcomes in community-dwelling older people. This was a retrospective cohort study with a 2-year follow-up period among all patients in an urban primary care center aged 60 and older: 1,679 patients (987 women [59%], median age, 73 years [interquartile range, 65-81]). For each patient, a baseline FI score was computed as the number of health deficits present divided by the total number of 36 deficits on the FI. Adverse health outcomes were defined as the first registered event of an emergency department (ED) or after-hours GP visit, nursing home admission, or death. In total, 508 outcome events occurred within the sample population. Kaplan-Meier survival curves were constructed according to FI tertiles. The tertiles were able to discriminate between patients with low, intermediate, and high risk for adverse health outcomes (p value < .001). With adjustments for age, consultation gap, and sex, a one deficit increase in the FI score was associated with an increased hazard for adverse health outcomes (hazard ratio, 1.166; 95% confidence interval [CI], 1.129-1.210) and a moderate predictive ability for adverse health outcomes (c-statistic, 0.702; 95% CI, 0.680-0.724). An FI based on International Classification of Primary Care (ICPC)-encoded routine health care data does predict the risk of adverse health outcomes in elderly population.
                Bookmark

                Author and article information

                Contributors
                H.M.Smeets@umcutrecht.nl
                M.F.kortekaas@umcutrecht.nl
                F.H.Rutten@umcutrecht.nl
                M.L.Bots@umcutrecht.nl
                vanderkraan@huisartsenutrechtstad.nl
                GDaggelders@ghcdebilt.nl
                HSmits@lrjg.nl
                C.W.Helsper-2@umcutrecht.nl
                A.W.Hoes@umcutrecht.nl
                N.J.dewit@umcutrecht.nl
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                25 September 2018
                25 September 2018
                2018
                : 18
                : 735
                Affiliations
                [1 ]ISNI 0000000090126352, GRID grid.7692.a, Julius Centre for Health Sciences and Primary Care, , University Medical Centre Utrecht, ; P.O. Box 85500, 3508 GA Utrecht, The Netherlands
                [2 ]General practice De Grebbe, Rhenen, The Netherlands
                [3 ]General practice Mariahoek aan de Singel, Utrecht, The Netherlands
                [4 ]General practice Health Centre De Bilt, De Bilt, The Netherlands
                [5 ]General practice Health Centres Leidsche Rijn, Utrecht, The Netherlands
                Article
                3528
                10.1186/s12913-018-3528-5
                6156960
                30253760
                90eba087-c281-448d-8137-3e33e0f8405e
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 7 December 2017
                : 7 September 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Health & Social care
                electronic medical record,quality of care,database,research,icpc
                Health & Social care
                electronic medical record, quality of care, database, research, icpc

                Comments

                Comment on this article