Considerations for observational study design: Comparing the evidence of opioid use between electronic health records and insurance claims. Issue 8 (23rd May 2022)

• Record Type: Journal Article
• Authors: Young, Jessica C.; Dasgupta, Nabarun; Stürmer, Til; Pate, Virginia; Jonsson Funk, Michele
• Is Part Of: Pharmacoepidemiology and drug safety. Volume 31:Issue 8(2022)
• Page Start: 913
• Page End: 920
• Publication Date: 2022-05-23
• Subjects: data linkage -- EHR -- insurance claims -- opioids -- pharmacoepidemiology; Pharmacoepidemiology -- Periodicals; Chemotherapy -- Periodicals; Epidemiology -- Periodicals; 615.705
• DOI: 10.1002/pds.5452
• Languages: English
• ISSNs: 1053-8569

Abstract

Abstract: Purpose: Pharmacoepidemiology studies often use insurance claims and/or electronic health records (EHR) to capture information about medication exposure. The choice between these data sources has important implications. Methods: We linked EHR from a large academic health system (2015–2017) to Medicare insurance claims for patients undergoing surgery. Drug utilization was characterized based on medication order dates in the EHR, and prescription fill dates in Medicare claims. We compared opioid use documented in EHR orders to prescription claims in four time periods: 1) Baseline (182 days before surgery); 2) Perioperative period; 3) Discharge date; 4) Follow‐up (90 days after surgery). Results: We identified 11 128 patients undergoing surgery. During baseline, 34.4% (EHR) versus 44.1% (claims) had evidence of opioid use, and 56.9% of all baseline use was reflected only in one data source. During the perioperative period, 78.8% (EHR) versus 47.6% (claims) had evidence of use. On the day of discharge, 59.6% (EHR) versus 45.5% (claims) had evidence of use, and 51.8% of all discharge use was reflected only in one data source. During follow‐up, 4.3% (EHR) versus 10.4% (claims) were identified with prolonged opioid use following surgery with 81.4% of all prolonged use reflected only in one data source. Conclusions: When characterizing opioid exposure, we found substantial discrepancies between EHR medication orders and prescription claims data. In all time periods assessed, most patients' use was reflected only in the EHR, or only in the claims, not both. The potential for misclassification of drug utilization must be evaluated carefully, and choice of data source may have large impacts on key study design elements. Plain Language Summary: Observational studies of large populations often use insurance claims and/or electronic health records (EHR) to efficiently examine medication use. Claims and EHR are both extremely valuable for enabling timely research, and each data source has different advantages and disadvantages. We examine how the choice between claims and EHR can impact estimates of opioid exposure before, during, and after surgery. For a population of Medicare patients undergoing surgery, we linked their insurance claims with their EHR. We then summarize the percent of patients with evidence of opioid use documented in the EHR, and the percent with opioid use documented in the insurance claims. We found that there were substantial discrepancies between EHR and claims data. For most patients who had evidence of opioid use, the use was documented in only one data source, not both. This suggests that in certain scenarios, the choice of dataset may provide different conclusions when trying to understand the percent of surgical patients who are using opioids. Researchers will need to be thoughtful when using these data and must understand how to choose which datasource is most appropriate for the research question at hand.