Denominators Matter: Understanding Medical Encounter Frequency and Its Impact on Surveillance Estimates Using EHR Data

EGEMS
Noelle M CocorosMichael Klompas

Abstract

There is scant guidance for defining what denominator to use when estimating disease prevalence via electronic health record (EHR) data. Describe the intervals between medical encounters to inform the selection of denominators for population-level disease rates, and evaluate the impact of different denominators on the prevalence of chronic conditions. We analyzed the EHRs of three practices in Massachusetts using the Electronic medical record Support for Public Health (ESP) system. We identified adult patients' first medical encounter per year (2011-2016) and counted days to next encounter. We estimated the prevalence of asthma, hypertension, obesity, and smoking using different denominators in 2016: ≥1 encounter in the past one year or two years and ≥2 encounters in the past one year or two years. In 2011-2016, 1,824,011 patients had 28,181,334 medical encounters. The median interval between encounters was 46, 56, and 66 days, depending on practice. Among patients with one visit in 2014, 82-84 percent had their next encounter within 1 year; 87-91 percent had their next encounter within two years. Increasing the encounter interval from one to two years increased the denominator by 23 percent. The prevalence of asthma, hypertens...Continue Reading

References

Nov 26, 2014·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Richard Birtwhistle, Tyler Williamson
Jan 22, 2015·Population Health Management·Margaret M PaulMarc N Gourevitch
Jul 21, 2017·American Journal of Public Health·Michael KlompasThomas Land

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