A Systematic Framework for Analyzing Observation Data in Patient-Centered Registries: Case Study for Patients With Depression

Background Patient-centered registries are essential in population-based clinical care for patient identification and monitoring of outcomes. Although registry data may be used in real time for patient care, the same data may further be used for secondary analysis to assess disease burden, evaluation of disease management and health care services, and research. The design of a registry has major implications for the ability to effectively use these clinical data in research. Objective This study aims to develop a systematic framework to address the data and methodological issues involved in analyzing data in clinically designed patient-centered registries. Methods The systematic framework was composed of 3 major components: visualizing the multifaceted and heterogeneous patient-centered registries using a data flow diagram, assessing and managing data quality issues, and identifying patient cohorts for addressing specific research questions. Results Using a clinical registry designed as a part of a collaborative care program for adults with depression at Mayo Clinic, we were able to demonstrate the impact of the proposed framework on data integrity. By following the data cleaning and refining procedures of the framework, we were able to generate high-quality data that were available for research questions about the coordination and management of depression in a primary care setting. We describe the steps involved in converting clinically collected data into a viable research data set using registry cohorts of depressed adults to assess the impact on high-cost service use. Conclusions The systematic framework discussed in this study sheds light on the existing inconsistency and data quality issues in patient-centered registries. This study provided a step-by-step procedure for addressing these challenges and for generating high-quality data for both quality improvement and research that may enhance care and outcomes for patients. International Registered Report Identifier (IRRID) DERR1-10.2196/18366

[1]  Isabel Segura-Bedmar,et al.  Cohort selection for clinical trials using deep learning models , 2019, J. Am. Medical Informatics Assoc..

[2]  Ajit Londhe,et al.  Extending Achilles Heel Data Quality Tool with New Rules Informed by Multi-Site Data Quality Comparison , 2019, MedInfo.

[3]  P. Franklin,et al.  The Essential Role of Patient-Centered Registries in an Era ofElectronic Health Records , 2018 .

[4]  Lauren A. Peccoralo,et al.  Providing Mental Health Services in the Primary Care Setting: the Experiences and Perceptions of General Practitioners at a New York City Clinic , 2018, Psychiatric Quarterly.

[5]  Z. Su,et al.  Managing Missing Data in Patient Registries , 2018 .

[6]  Q. Gu,et al.  Antidepressant Use Among Persons Aged 12 and Over:United States,2011-2014. , 2017, NCHS data brief.

[7]  P. Kaufmann,et al.  Early Vision for the CTSA Program Trial Innovation Network: A Perspective from the National Center for Advancing Translational Sciences , 2017, Clinical and translational science.

[8]  Managing Missing Data in Patient Registries Research White Paper Managing Missing Data in Patient Registries Addendum to Registries for Evaluating Patient Outcomes: A User’s Guide, Third Edition , 2017 .

[9]  J. Lake,et al.  Urgent Need for Improved Mental Health Care and a More Collaborative Model of Care. , 2017, The Permanente journal.

[10]  Domenica Taruscio,et al.  Data Quality in Rare Diseases Registries. , 2017, Advances in experimental medicine and biology.

[11]  Tom De Marco,et al.  Structured Analysis And System Specification , 2015 .

[12]  Laura Manea,et al.  Screening and case finding for major depressive disorder using the Patient Health Questionnaire (PHQ-9): a meta-analysis. , 2015, General hospital psychiatry.

[13]  H. Cameron,et al.  Exploring patterns of error in acute care using framework analysis , 2015, BMC medical education.

[14]  Lee Render,et al.  A Registry Framework Enabling Patient-Centred Care. , 2015, Studies in health technology and informatics.

[15]  Michelle B. Leavy,et al.  Analysis, Interpretation, and Reporting of Registry Data To Evaluate Outcomes , 2014 .

[16]  N. Williams The GAD-7 questionnaire , 2014 .

[17]  P. Skorga,et al.  Collaborative care for depression and anxiety problems , 2013 .

[18]  S. Cha,et al.  Antidepressant Medication Use Among Patients with Depression: Comparison between Usual Care and Collaborative Care Using Care Managers , 2013, Clinical practice and epidemiology in mental health : CP & EMH.

[19]  P. Bower,et al.  Collaborative care for depression and anxiety problems. , 2012, The Cochrane database of systematic reviews.

[20]  J. Steiner,et al.  A pragmatic framework for single-site and multisite data quality assessment in electronic health record-based clinical research. , 2012, Medical care.

[21]  N. Dreyer,et al.  Registries for Evaluating Patient Outcomes: A User’s Guide , 2010 .

[22]  Patients in a Depression Collaborative Care Model of Care , 2010, Journal of primary care & community health.

[23]  S. Ghaemi,et al.  Sensitivity and specificity of the Mood Disorder Questionnaire for detecting bipolar disorder. , 2004, Journal of affective disorders.

[24]  Mark T Hegel,et al.  Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. , 2002, JAMA.

[25]  M. Uguccioni,et al.  [AHCPR/AHRQ guidelines. Agency for Health Care Policy and Research and Agency for Health Care Research and Quality]. , 2001, Italian heart journal : official journal of the Italian Federation of Cardiology.

[26]  Phyllis S. Gabriel,et al.  Mental health and work : impact, issues, and good practices , 2000 .

[27]  Richard Thomas,et al.  Introduction to the Unified Modeling Language , 1997, Proceedings. Technology of Object-Oriented Languages and Systems, TOOLS 25 (Cat. No.97TB100239).

[28]  The AUDIT questionnaire: choosing a cut-off score. Alcohol Use Disorder Identification Test. , 1995, Addiction.

[29]  Tom DeMarco,et al.  Structured Analysis and System Specification , 1978 .

[30]  Sho Tin Chen,et al.  National Institute of Mental Health , 2020, Definitions.