title: Variations in measurement of sexual activity based on EHR definitions.
abstract: OBJECTIVE
  The goal of this study was to compare the performance of 4 operational definitions of sexual activity by using data electronically abstracted from electronic health records (EHRs) and examine how documentation of Chlamydia screening and positivity vary according to definition of sexual activity.
  
  
  METHODS
  Extracts were created from EHRs of adolescent females 12 to 19 years old who had ≥1 visit to a primary care practice during 2011 at 4 US pediatric health care organizations. We created 4 definitions of sexual activity derived from electronically abstracted indicator variables. Percent sexually active, documentation of Chlamydia screening, and rate of positive Chlamydia test results per 1000 adolescent females according to the sexual activity definition were calculated.
  
  
  RESULTS
  The most commonly documented individual indicator of sexual activity was "patient report of being sexually active" (mean across 4 sites: 19.2%). The percentage of adolescent females classified as sexually active varied by site and increased as more indicator variables were included. As the definition of sexual activity expanded, the percentage of sexually active females who received at least 1 Chlamydia test decreased. Using a broader definition of sexual activity resulted in improved identification of adolescent females with Chlamydia infection. For each sexual activity definition and performance item, the difference was statistically significant (P < .0001).
  
  
  CONCLUSIONS
  Information about sexual activity may be gathered from a variety of data sources, and changing the configurations of these indicators results in differences in the percentage of adolescent females classified as sexually active, screened for Chlamydia infection, and Chlamydia infection rates.
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Section of Adolescent Medicine, Nationwide Children's Hospital, Columbus, Ohio; Centers for Clinical and Translational Research, and elise.berlan@nationwidechildrens.org.
authors.forename: Elise D
authors.initials: ED
authors.lastname: Berlan
authors.affiliation: National Committee for Quality Assurance, Washington, District of Columbia.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Ireland
authors.affiliation: National Committee for Quality Assurance, Washington, District of Columbia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Morton
authors.affiliation: National Committee for Quality Assurance, Washington, District of Columbia.
authors.forename: Sepheen C
authors.initials: SC
authors.lastname: Byron
authors.affiliation: Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; and.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Canan
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio; Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio; and.
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Kelleher
mesh_terms: D000293:Adolescent; D002648:Child; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission; D003268:Contraception Behavior / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008403:Mass Screening; D011247:Pregnancy; D011320:Primary Health Care; D012650:Self Disclosure; D012725:Sexual Behavior / Q000145:classification / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000635:transmission; D055815:Young Adult
keywords: adolescent; electronic health records; health care quality assessment; sexual activity