title: Going Beyond Administrative Data: Retrospective Evaluation of an Algorithm Using the Electronic Health Record to Help Identify Bleeding Events Among Hospitalized Medical Patients on Warfarin.
abstract: To reliably assess quality, a standardized electronic approach is needed to identify bleeding events. The study aims were the following: (1) clinically validate an electronic health record-based algorithm for bleeding and (2) assess interrater results to determine validity and reliability. Data were analyzed before and after implementation of a pharmacist-managed warfarin protocol. Bleeding was based on ≥2 of 3 criteria: (1) diagnosis indicating bleeding, (2) lab value decrease suggesting bleeding, and (3) blood product use. All suspected bleeds (234) and a sample (58) not meeting criteria were compared with clinical review. There were 234 bleeding cases identified electronically. Reviewer agreement was 78.2% (κ = 0.565). Algorithm sensitivity was 93.9% and positive predictive value 46.2%. Algorithm identification was least accurate for those with only 2 criteria but good for those with all criteria. This study supports using multiple electronic criteria to identify bleeding events. However, cases having exactly 2 criteria may require manual review for validation.
authors.affiliation: 1 Mayo Clinic, Rochester, MN.
authors.forename: James P
authors.initials: JP
authors.lastname: Moriarty
authors.affiliation: 1 Mayo Clinic, Rochester, MN.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Daniels
authors.affiliation: 1 Mayo Clinic, Rochester, MN.
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Manning
authors.affiliation: 1 Mayo Clinic, Rochester, MN.
authors.forename: John G
authors.initials: JG
authors.lastname: O'Meara
authors.affiliation: 1 Mayo Clinic, Rochester, MN.
authors.forename: Narith N
authors.initials: NN
authors.lastname: Ou
authors.affiliation: 1 Mayo Clinic, Rochester, MN.
authors.forename: Tamara M
authors.initials: TM
authors.lastname: Berg
authors.affiliation: 1 Mayo Clinic, Rochester, MN.
authors.forename: Jordan D
authors.initials: JD
authors.lastname: Haag
authors.affiliation: 1 Mayo Clinic, Rochester, MN.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Roellinger
authors.affiliation: 1 Mayo Clinic, Rochester, MN.
authors.forename: James M
authors.initials: JM
authors.lastname: Naessens
mesh_terms: D000465:Algorithms; D000925:Anticoagulants / Q000009:adverse effects*; D002985:Clinical Protocols; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D006801:Humans; D008297:Male; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014859:Warfarin / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: algorithms; electronic health records; hemorrhage; warfarin