title: Evidence-based rules from family practice to inform family practice; the learning healthcare system case study on urinary tract infections.
abstract: BACKGROUND
  Analysis of encounter data relevant to the diagnostic process sourced from routine electronic medical record (EMR) databases represents a classic example of the concept of a learning healthcare system (LHS). By collecting International Classification of Primary Care (ICPC) coded EMR data as part of the Transition Project from Dutch and Maltese databases (using the EMR TransHIS), data mining algorithms can empirically quantify the relationships of all presenting reasons for encounter (RfEs) and recorded diagnostic outcomes. We have specifically looked at new episodes of care (EoC) for two urinary system infections: simple urinary tract infection (UTI, ICPC code: U71) and pyelonephritis (ICPC code: U70).
  
  
  METHODS
  Participating family doctors (FDs) recorded details of all their patient contacts in an EoC structure using the ICPC, including RfEs presented by the patient, and the FDs' diagnostic labels. The relationships between RfEs and episode titles were studied using probabilistic and data mining methods as part of the TRANSFoRm project.
  
  
  RESULTS
  The Dutch data indicated that the presence of RfE's "Cystitis/Urinary Tract Infection", "Dysuria", "Fear of UTI", "Urinary frequency/urgency", "Haematuria", "Urine symptom/complaint, other" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection" . The Maltese data indicated that the presence of RfE's "Dysuria", "Urinary frequency/urgency", "Haematuria" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection". The Dutch data indicated that the presence of RfE's "Flank/axilla symptom/complaint", "Dysuria", "Fever", "Cystitis/Urinary Tract Infection", "Abdominal pain/cramps general" are all strong, reliable, predictors for the diagnosis "Pyelonephritis" . The Maltese data set did not present any clinically and statistically significant predictors for pyelonephritis.
  
  
  CONCLUSIONS
  We describe clinically and statistically significant diagnostic associations observed between UTIs and pyelonephritis presenting as a new problem in family practice, and all associated RfEs, and demonstrate that the significant diagnostic cues obtained are consistent with the literature. We conclude that it is possible to generate clinically meaningful diagnostic evidence from electronic sources of patient data.
authors.affiliation: Mediterranean Institute of Primary Care 19, Triq ir-Rand, Attard, Malta. jksoler@synapse.net.mt.
authors.forename: Jean K
authors.initials: JK
authors.lastname: Soler
authors.affiliation: Department of General Practice, HRB Centre for Primary Care Research, Beaux Lane House, Lower Mercer Street, Dublin, Ireland. derekcorrigan@rcsi.ie.
authors.forename: Derek
authors.initials: D
authors.lastname: Corrigan
authors.affiliation: Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370, Wroclaw, Poland. kazienko@pwr.edu.pl.
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Kazienko
authors.affiliation: Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370, Wroclaw, Poland. tomasz.kajdanowicz@pwr.edu.pl.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kajdanowicz
authors.affiliation: Imperial College London, London, UK. r.danger@imperial.ac.uk.
authors.forename: Roxana
authors.initials: R
authors.lastname: Danger
authors.affiliation: Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370, Wroclaw, Poland. marcin.kulisiewicz@pwr.edu.pl.
authors.forename: Marcin
authors.initials: M
authors.lastname: Kulisiewicz
authors.affiliation: Wolfson Chair of General Practice, King's College London, Capital House, Guy's Hospital, London, England. brendan.delaney@kcl.ac.uk.
authors.forename: Brendan
authors.initials: B
authors.lastname: Delaney
mesh_terms: D057225:Data Mining; D003661:Decision Support Techniques; D057286:Electronic Health Records / Q000592:standards*; D017050:Episode of Care; D005194:Family Practice / Q000379:methods / Q000592:standards; D006801:Humans; D038801:International Classification of Diseases; D008319:Malta; D015233:Models, Statistical; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000379:methods / Q000592:standards; D011704:Pyelonephritis / Q000175:diagnosis*; D015203:Reproducibility of Results; D014552:Urinary Tract Infections / Q000175:diagnosis*