Elsevier

American Heart Journal

Volume 263, September 2023, Pages 64-72
American Heart Journal

Clinical Investigations
Generalizability of an EHR-network dataset to the United States for cardiovascular disease conditions: Comparison of Cerner real world data with the national inpatient sample

https://doi.org/10.1016/j.ahj.2023.05.009Get rights and content

Background

Electronic Health Record (EHR) data from health systems are increasingly being combined for clinical research purposes. Yet, it remains unclear whether these large EHR data sources provide a representative assessment of national disease prevalence and treatment. To evaluate this, we compared Cerner RealWorldData (CRWD), a large EHR data source, to those seen in the National Inpatient Sample (NIS) for 3 cardiovascular conditions (myocardial infarction (MI), congestive heart failure (CHF), and stroke.

Methods

Adult patients (age ≥18 years) hospitalized with MI, CHF, and stroke were identified in both CRWD (86 health systems) and the NIS (4,782 hospitals). Patient demographics, comorbidities, procedures, outcomes (length of stay and in-hospital mortality) and hospital type (teaching or nonteaching) were compared between NIS and CRWD patients.

Results

Of 86 health systems participating in CRWD, 33 were excluded for potential data quality issues which accounted for about 11% of hospitalizations in the dataset, leaving 53 for inclusion in analysis which accounted for about 89% of hospitalizations in the dataset. Between January 1, 2017 and December 31, 2018, 116,956 MI, 188,107 CHF, and 93,968 stroke hospitalizations were identified in CRWD vs 2,245,300 MI, 4,310,745 CHF, and 1,333,480 stroke hospitalizations in the NIS. Patient demographics were similar among patients in CWRD and the NIS for all 3 cardiovascular groups except for ethnicity, with underrepresentation of Hispanic individuals in CRWD vs the NIS. Patients hospitalized in CRWD had a slightly higher proportion of coded co-morbidities compared with NIS hospitalizations due to a longer potential look-back period. For patients with MI, hospital mortality, length of stay, coronary artery bypass graft (CABG) rates, and percutaneous coronary intervention (PCI) rates were similar between CRWD and NIS. Additionally, there was similar in hospital mortality and length of stay for those with CHF and stroke hospitalizations between CRWD and NIS.

Conclusions

On aggregate, characteristics of hospitalizations for MI, CHF, and stroke using EHR data from one nationwide EHR-derived database, CRWD, appears similar to characteristics of hospitalizations in the nationally representative NIS. Important limitations of CRWD include lack of geographic representativeness, under-representation of Hispanic adults, and the need to exclude health systems for missing data.

Section snippets

Cerner real world data

Health systems in the United States who use Cerner's EHR or Cerner's population health management platform are eligible to participate in CRWD. Systems who opt-in contribute EHR data from both Cerner and, if necessary, non-Cerner EHRs from their health system. Data are mapped to a Cerner-specific common data model, fully de-identified, and made available to researchers for analyses on a cloud-based data science platform.

We used data from CRWD to identify all adult (age >18) hospitalizations for

Results

Initially, 86 health systems were included contributing data to CRWD, representing 6,612,117 hospitalizations (range 4-987,711, median 35,729, interquartile range 3,308-85,630) between January 1, 2017 and December 31, 2018. Among these, 33 health systems were excluded for either not identifying final diagnoses for the hospitalization, or being hospitalized in a system with 30 or fewer patients with MIs during the study period (eg, children's hospitals). Characteristics of health systems that

Discussion

Our analysis overall found that EHR data from, CRWD, an aggregate EHR based network, was closely matched to data found in the NIS. In particular, we found that demographics, procedure rates, and hospitalization outcomes were similar for patients hospitalized for MI, CHF, and stroke. Overall, these analyses support the representativeness and generalizability of CRWD as a source to evaluate national-level patterns of care and outcomes for cardiovascular disease.

The NIS has long been used for

Funding

This project was supported by grant funding to Duke University and UT Southwestern Medical Center from Janssen. The sponsor had no role in the development of the analytic plan, data analysis, data interpretation, or decision to publish.

Disclosures

NP Shah has received research funding from Amgen, Janssen, and Novartis, and honoraria and consulting fees from Amgen, Novartis, and Esperion. AM Navar and ED Peterson receive research funding to their institution for research from Bristol Myers Squibb outside the scope of this research project, consulting fees for research consulting from Bristol Myers Squibb, Boehringer Ingelheim, and Janssen Pharmaceuticals, and consulting fees for research advising from Cerner outside of this project. The

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