Dove Medical Press - Open Access Publisher of Medical Journals
Figure S1. Study design diagramTable S1. Prediction model for EHR data-continuity cohortVariableCoefficientIntercept-0.010Having seen the same provider twice0.049Having seen the same provider >=3 times0.087Having general medical exam*0.078Mammography*0.075Pap smear*0.009PSA Test*0.103Colonoscopy*0.064Fecal occult blood test*0.034Influenza vaccine*0.102Pneumococcal vaccine*0.031Having BMI recorded*0.017Having 2 of the above routine care facts**0.049With any one medication use record0.002With at least 2 medication use records0.074Having A1C ordered or value recorded*0.018Having at least one inpatient or outpatient encounter0.091Having at least two outpatient encounters0.050With 1 diagnosis recorded in the EHR-0.026With at least 2 diagnoses recorded in the EHR0.037Having any ED visit in the EHR0.078** having 2 of the facts followed by *, EHR=electronic health records, PSA= prostate specific antigenTable S2: The 40 patient characteristics to be assessed for accuracy of classification 25 co-morbidity variables15 variables commonly used as covariates for confounding adjustment: Dementia, atrial fibrillation, chronic lung disease, chronic liver disease, chronic kidney disease, cancer, diabetes, hypertension, anemia, psychosis, depression, pneumonia, HIV, fracture, and RA10 variables with validated algorithm commonly used as outcome variables: ischemic stroke, ICH, MI, AKI, hepatotoxicity, GI Bleeding, major bleeding, DVT, PE, and CHFPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CaXJtYW4tRGV5Y2g8L0F1dGhvcj48WWVhcj4yMDA1PC9Z
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ADDIN EN.CITE.DATA 1815 medication use variablesantiplatelet agents, antidiabetics, antihypertensives, NSAIDs, opioids, antidepressants, antipsychotics, anticonvulsants, PPIs, antiarrhythmics, statins, dementia, hormone therapy, antibiotics, and oral anticoagulantsCHF= congestive heart failure, HIV= human immunodeficiency virus, RA=rheumatoid arthritis, AKI=acute kidney injury, ICH= intracranial hemorrhage, MI= myocardial infarction, PE= pulmonary embolism, DVT= deep vein thrombosis, NSAIDs= nonsteroidal anti-inflammatory drugs, PPI= Proton pump inhibitorsTable S3. Patients population comparison between MA vs. NC sitesVariableTraining (MA) set, n=80,588N (%)Validation (NC) set, n=33,207N (%)Absolute Standardized Mean DifferenceMean (SD) age, years74.1 (7.7)73.7 (7.4)0.00Female60,217 (57.7)29,544 (60.0)0.05Mean (SD) CCS2.3 (3.3)2.0 (3.0)0.00Dementia11,776 (11.3)5,603 (11.4)0.00Atrial fibrillation19,144 (18.3)8,044 (16.3)0.05Chronic lung disease21,334 (20.4)11,347 (23.0)0.06Chronic liver disease8,119 (7.8)2,772 (5.6)0.09Chronic kidney disease14,524 (13.9)7,233 (14.7)0.02Cancer44,980 (43.1)19,628 (39.8)0.07Diabetes23,074 (22.1)13,993 (28.4)0.15Hypertension84,184 (80.6)41,402 (84.0)0.09Anemia30,455 (29.2)14,825 (30.1)0.02Psychosis5,201 (5.0)2,142 (4.4)0.03Depression21,085 (20.2)8,717 (17.7)0.06Pneumonia11,438 (11.0)5,336 (10.8)0.00HIV147 (0.1)77 (0.2)0.01Fracture3,569 (3.4)1,699 (3.5)0.00RA2,775 (2.7)1,680 (3.4)0.04Ischemic stroke1,127 (1.1)675 (1.4)0.03ICH*592 (0.6)238 (0.5)0.01MI*1,107 (1.1)517 (1.1)0.00AKI*5,941 (5.7)2,964 (6.0)0.01Hepatotoxicity*346 (0.3)153 (0.3)0.00GI Bleeding*2,001 (1.9)1,100 (2.2)0.02Major bleeding*4,644 (4.5)3,015 (6.1)0.07DVT*958 (0.9)428 (0.9)0.01PE*660 (0.6)368 (0.8)0.01CHF*11,701 (11.2)5,342 (10.8)0.01EHR= electronic health record, stand. Diff. = standardized difference, CHF= congestive heart failure, HIV= human immunodeficiency virus, RA=rheumatoid arthritis, AKI=acute kidney injury, ICH= intracranial hemorrhage, MI= myocardial infarction, PE= pulmonary embolism, DVT= deep vein thrombosis, NSAIDs= nonsteroidal anti-inflammatory drugs, PPI= Proton pump inhibitors. * Variables based on validated algorithms commonly used to define study outcomesPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CaXJtYW4tRGV5Y2g8L0F1dGhvcj48WWVhcj4yMDA1PC9Z
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ADDIN EN.CITE.DATA 18. Table S4. Correlation between predicted vs. observed EHR data-continuity measured by Spearman coefficients DatasetTraining (MA) setValidation set (NC)Overall population0.780.73Age groups 65-<750.780.72 75-<850.790.73 >=850.760.73Gender female0.780.74 male0.770.72Ethnicity white0.760.73 black0.760.70 others0.820.75CCS <=00.760.74 1-20.780.76 >=20.780.73CCS= combined comorbidity score (J Clin Epidemiol. 2011;64 [7]:749-759). The higher the score, the higher the mortality.Table S5-1. Representativeness of the EHR data-continuity cohort in the training (MA) setLow EHR data-continuity N (%)*High EHR data-continuity N (%)**Stand. Diff.***Mean age (SD)74.1 (7.6)72.7 (7.2)0.18Female, %55,119 (58.6)12,804 (56.1)0.05Dementia10,916 (11.6)1,772 (7.8)0.13Atrial fibrillation17,305 (18.4)3,689 (16.2)0.06Chronic lung disease18,937 (20.1)4,512 (19.8)0.01Liver disease6,925 (7.4)1,992 (8.7)0.05Chronic kidney disease12,286 (13.1)3,385 (14.8)0.05Cancer40,593 (43.1)10,001 (43.8)0.01Diabetes19,696 (20.9)5,427 (23.8)0.07Hypertension73,727 (78.3)18,695 (81.9)0.09Anemia27,218 (28.9)6,274 (27.5)0.03Psychosis4,676 (5.0)914 (4.0)0.05Depression18,684 (19.9)4,741 (20.8)0.02Pneumonia10,012 (10.6)2,379 (10.4)0.01HIV103 (0.1)55 (0.2)0.03Fracture3,204 (3.4)670 (2.9)0.03RA2,572 (2.7)686 (3.0)0.02Ischemic stroke5,043 (5.4)1,061 (4.7)0.03ICH1,995 (2.1)394 (1.7)0.03MI842 (0.9)238 (1.0)0.02AKI5,164 (5.5)1,375 (6.0)0.02Hepatotoxicity1,010 (1.1)377 (1.7)0.05GI bleeding6,506 (6.9)1,674 (7.3)0.02Major bleeding12,345 (13.1)3,272 (14.3)0.04DVT4,256 (4.5)1,066 (4.7)0.01PE1,802 (1.9)491 (2.2)0.02CHF10,288 (10.9)2,343 (10.3)0.02*Patients in the lower 8 deciles of predicted EHR data-continuity;**Patients in the top 2 deciles of predicted EHR data-continuity***Stand diff= Standardized difference. CHF= congestive heart failure, HIV= human immunodeficiency virus, RA=rheumatoid arthritis, AKI=acute kidney injury, ICH= intracranial hemorrhage, MI= myocardial infarction, PE= pulmonary embolism, DVT= deep vein thrombosis, NSAIDs= nonsteroidal anti-inflammatory drugs, PPI= Proton pump inhibitorsTable S5-2. Representativeness of the EHR data-continuity cohort in NC datasetLow EHR data-continuity N (%)*High EHR data-continuity N (%)**Stand. Diff.***Mean age (SD)73.9 (7.4)72.8 (7.1)0.16Female, %25,333 (60.3)4,211 (57.7)0.05Dementia4,743 (11.3)725 (9.9)0.04Atrial fibrillation6,649 (15.8)1,280 (17.5)0.05Chronic lung disease9,440 (22.5)1,682 (23.1)0.01Liver disease2,144 (5.1)500 (6.9)0.07Chronic kidney disease5,704 (13.6)1,327 (18.2)0.13Cancer16,201 (38.6)2,951 (40.4)0.04Diabetes11,287 (26.9)2,537 (34.8)0.17Hypertension34,527 (82.2)6,264 (85.8)0.10Anemia11,894 (28.3)2,553 (35.0)0.14Psychosis1,741 (4.1)303 (4.2)0.00Depression7,008 (16.7)1,383 (19.0)0.06Pneumonia4,334 (10.3)858 (11.8)0.05HIV33 (0.1)38 (0.5)0.08Fracture1,378 (3.3)282 (3.9)0.03RA1,392 (3.3)266 (3.6)0.02Ischemic stroke524 (1.2)138 (1.9)0.05ICH182 (0.4)48 (0.7)0.03MI364 (0.9)119 (1.6)0.07AKI2,208 (5.3)684 (9.4)0.16Hepatotoxicity118 (0.3)28 (0.4)0.02GI bleeding810 (1.9)254 (3.5)0.10Major bleeding2,097 (5.0)833 (11.4)0.24DVT319 (0.8)99 (1.4)0.06PE280 (0.7)82 (1.1)0.05CHF4,342 (10.3)932 (12.8)0.08*Patients in the lower 8 deciles of predicted EHR data-continuity;**Patients in the top 2 deciles of predicted EHR data-continuity***Stand diff= Standardized difference. CHF= congestive heart failure, HIV= human immunodeficiency virus, RA=rheumatoid arthritis, AKI=acute kidney injury, ICH= intracranial hemorrhage, MI= myocardial infarction, PE= pulmonary embolism, DVT= deep vein thrombosis, NSAIDs= nonsteroidal anti-inflammatory drugs, PPI= Proton pump inhibitorsTable S6. Representative assessment: discrepancy* of a comorbidity score** category in patients with high vs. low care-continuityYear after cohort entry:1234567MATop decile vs. the rest, training set0.010.020.020.020.020.030.04Top two deciles vs. the rest, training set0.020.020.020.020.020.020.02NCTop decile vs. the rest, validation set0.060.050.050.040.030.030.03Top two deciles vs. the rest, validation set0.050.040.040.040.030.030.03* Quantified by mean standardized difference (MSD); a MSD of <0.1 indicates acceptable discrepancy**combined comorbidity score [J Clin Epidemiol. 2011;64(7):749-759.] ................
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