Validity of diagnostic coding within the General Practice Research Database: a systematic review.
BACKGROUND
The UK-based General Practice Research Database (GPRD) is a valuable source of longitudinal primary care records and is increasingly used for epidemiological research.


OBJECTIVE
To conduct a systematic review of the literature on accuracy and completeness of diagnostic coding in the GPRD.


METHODS
Systematic review.


METHODS
Six electronic databases were searched using search terms relating to the GPRD, in association with terms synonymous with validity, accuracy, concordance, and recording. A positive predictive value was calculated for each diagnosis that considered a comparison with a gold standard. Studies were also considered that compared the GPRD with other databases and national statistics.


RESULTS
A total of 49 papers are included in this review. Forty papers conducted validation of a clinical diagnosis in the GPRD. When assessed against a gold standard (validation using GP questionnaire, primary care medical records, or hospital correspondence), most of the diagnoses were accurately recorded in the patient electronic record. Acute conditions were not as well recorded, with positive predictive values lower than 50%. Twelve papers compared prevalence or consultation rates in the GPRD against other primary care databases or national statistics. Generally, there was good agreement between disease prevalence and consultation rates between the GPRD and other datasets; however, rates of diabetes and musculoskeletal conditions were underestimated in the GPRD.


CONCLUSIONS
Most of the diagnoses coded in the GPRD are well recorded. Researchers using the GPRD may want to consider how well the disease of interest is recorded before planning research, and consider how to optimise the identification of clinical events.
Khan
Nada F
NF
Department of Primary Health Care, University of Oxford, Oxford, UK. nada.khan@dphpc.ox.ac.uk
Harrison
Sian E
SE
Rose
Peter W
PW
D003628:Database Management Systems / Q000592:standards*; D016208:Databases, Factual / Q000592:standards*; D019937:Diagnostic Techniques and Procedures; D004812:Epidemiologic Methods; D005194:Family Practice; D005568:Forms and Records Control; D006801:Humans; D016347:Medical Records Systems, Computerized / Q000592:standards*; D015203:Reproducibility of Results; D006113:United Kingdom