Linking laboratory and medication data: new opportunities for pharmacoepidemiological research
-
Maarten J. ten Berg
Abstract
Transfer of automated laboratory data collected during routine clinical care from the laboratory information system into a database format that enables linkage to other administrative (e.g., patient characteristics) or clinical (e.g., medication, diagnoses, procedures) data provides a valuable tool for clinical epidemiological research. It allows the investigation of biochemical characteristics of diseases, therapeutic effects and diagnostic and/or prognostic markers for disease with easy access and at relatively low cost. To this end, the Utrecht Patient Oriented Database (UPOD), an infrastructure of relational databases comprising data on patient characteristics, laboratory test results, medication orders, hospital discharge diagnoses and medical procedures for all patients treated at the University Medical Centre Utrecht since January 2004, was established. Current research within UPOD is focused on the innovative linkage of laboratory and medication data, which, for example, makes it possible to assess the quality of pharmacotherapy in clinical practice, to investigate interference between laboratory tests and drugs, to study the risk of adverse drug reactions, and to develop diagnostic and prognostic markers or algorithms for adverse drug reactions. Although recently established, we believe that UPOD broadens the opportunities for clinical pharmacoepidemiological research and can contribute to patient care from a laboratory perspective.
Clin Chem Lab Med 2007;45:13–9.
References
1. Porth AJ, Lubke B. History of computer-assisted data processing in the medical laboratory. Eur J Clin Chem Clin Biochem1996;34:215–29.Suche in Google Scholar
2. Sackett D, Haynes RB, Tugwell P, Guyatt GH, editors. Clinical epidemiology: a basic science for clinical medicine, 2nd ed. Boston, MA: Little, Brown & Co., 1991.Suche in Google Scholar
3. Z-Index. [About the G-standard]. http://www.zindex.nl/ (in Dutch). Accessed July 6, 2006.Suche in Google Scholar
4. WHO Collaborating Centre for Drug Statistics Methodology. About the ATC/DDD system. http://www.whocc.no/atcddd/atcsystem.html. Accessed July 6, 2006.Suche in Google Scholar
5. CDC National Center for Health Statistics. International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). http://www.cdc.gov/nchs/about/otheract/icd9/abticd9.html. Accessed July 6, 2006.Suche in Google Scholar
6. CBV Foundation. [About the classification of medical specialist procedures (CMSV)]. http://www.cbv.nl (in Dutch). Accessed July 6, 2006.Suche in Google Scholar
7. Muller R, Mellors I, Johannessen B, Aarsand AK, Kiefer P, Hardy J, et al. European multi-center evaluation of the Abbott Cell-Dyn Sapphire hematology analyzer. Lab Hematol2006;12:15–31.10.1532/LH96.05041Suche in Google Scholar PubMed
8. Ohno-Machado L, Silveira PS, Vinterbo S. Protecting patient privacy by quantifiable control of disclosures in disseminated databases. Int J Med Inform2004;73:599–606.10.1016/j.ijmedinf.2004.05.002Suche in Google Scholar PubMed
9. HodgeJG Jr, Gostin LO, Jacobson PD. Legal issues concerning electronic health information: privacy, quality, and liability. J Am Med Assoc1999;282:1466–71.10.1001/jama.282.15.1466Suche in Google Scholar PubMed
10. Schiff GD, Klass D, Peterson J, Shah G, Bates DW. Linking laboratory and pharmacy: opportunities for reducing errors and improving care. Arch Intern Med2003;163:893–900.10.1001/archinte.163.8.893Suche in Google Scholar PubMed
11. Gurwitz JH. Serious adverse drug effects – seeing the trees through the forest [editorial]. N Engl J Med2006;354:1413–5.10.1056/NEJMe068051Suche in Google Scholar PubMed
12. Warkentin TE, Greinacher A. Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest2004;126(Suppl):311S–37S.10.1378/chest.126.3_suppl.311SSuche in Google Scholar PubMed
13. Kelly WN. Potential risks and prevention, part 1: fatal adverse drug events. Am J Health Syst Pharm2001;58:1317–24.10.1093/ajhp/58.14.1317Suche in Google Scholar PubMed
14. van den Bemt PM, Meyboom RH, Egberts AC. Drug-induced immune thrombocytopenia. Drug Saf2004;27:1243–52.10.2165/00002018-200427150-00007Suche in Google Scholar PubMed
15. van Staa TP, Boulton F, Cooper C, Hagenbeek A, Inskip H, Leufkens HG. Neutropenia and agranulocytosis in England and Wales: incidence and risk factors. Am J Hematol2003;72:248–54.10.1002/ajh.10295Suche in Google Scholar PubMed
16. Wyrick-Glatzel J, Conway-Klaassen J. Clinical utility of the IRF: assessment of erythroid regeneration following parvo B19 infection. Clin Lab Sci2002;15:208–12.Suche in Google Scholar
17. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. J Am Med Assoc1998;279:1200–5.10.1001/jama.279.15.1200Suche in Google Scholar PubMed
18. van den Bemt PM, Egberts AC, de Jong-van den Berg LT, Brouwers JR. Drug-related problems in hospitalised patients. Drug Saf2000;22:321–33.10.2165/00002018-200022040-00005Suche in Google Scholar PubMed
19. Azaz-Livshits T, Levy M, Sadan B, Shalit M, Geisslinger G, Brune K. Computerized surveillance of adverse drug reactions in hospital: pilot study. Br J Clin Pharmacol1998;45:309–14.10.1046/j.1365-2125.1998.00685.xSuche in Google Scholar PubMed PubMed Central
20. Tegeder I, Levy M, Muth-Selbach U, Oelkers R, Neumann F, Dormann H, et al. Retrospective analysis of the frequency and recognition of adverse drug reactions by means of automatically recorded laboratory signals. Br J Clin Pharmacol1999;47:557–64.10.1046/j.1365-2125.1999.00926.xSuche in Google Scholar PubMed PubMed Central
21. Levy M, Azaz-Livshits T, Sadan B, Shalit M, Geisslinger G, Brune K. Computerized surveillance of adverse drug reactions in hospital: implementation. Eur J Clin Pharmacol1999;54:887–92.10.1007/s002280050571Suche in Google Scholar PubMed
22. Classen DC, Pestotnik SL, Evans RS, Burke JP. Computerized surveillance of adverse drug events in hospital patients. J Am Med Assoc1991;266:2847–51.10.1001/jama.266.20.2847Suche in Google Scholar
23. Dormann H, Muth-Selbach U, Krebs S, Criegee-Rieck M, Tegeder I, Schneider HT, et al. Incidence and costs of adverse drug reactions during hospitalisation: computerised monitoring versus stimulated spontaneous reporting. Drug Saf2000;22:161–8.10.2165/00002018-200022020-00007Suche in Google Scholar PubMed
24. Jha AK, Kuperman GJ, Teich JM, Leape L, Shea B, Rittenberg E, et al. Identifying adverse drug events: development of a computer-based monitor and comparison with chart review and stimulated voluntary report. J Am Med Inform Assoc1998;5:305–14.10.1136/jamia.1998.0050305Suche in Google Scholar PubMed PubMed Central
25. Honigman B, Lee J, Rothschild J, Light P, Pulling RM, Yu T, et al. Using computerized data to identify adverse drug events in outpatients. J Am Med Inform Assoc2001;8:254–66.10.1136/jamia.2001.0080254Suche in Google Scholar PubMed PubMed Central
26. Bagheri H, Michel F, Lapeyre-Mestre M, Lagier E, Cambus JP, Valdiguie P, et al. Detection and incidence of drug-induced liver injuries in hospital: a prospective analysis from laboratory signals. Br J Clin Pharmacol2000;50:479–84.10.1046/j.1365-2125.2000.00282.xSuche in Google Scholar PubMed PubMed Central
27. Movig KL, Leufkens HG, Lenderink AW, van den Akker VG, Hodiamont PP, Goldschmidt HM, et al. Association between antidepressant drug use and hyponatraemia: a case-control study. Br J Clin Pharmacol2002;53:363–9.10.1046/j.1365-2125.2002.01550.xSuche in Google Scholar PubMed PubMed Central
28. Hoorn EJ, Lindemans J, Zietse R. Development of severe hyponatraemia in hospitalized patients: treatment-related risk factors and inadequate management. Nephrol Dial Transplant2006;21:70–6.10.1093/ndt/gfi082Suche in Google Scholar
29. van den Bemt PM, Egberts AC, Lenderink AW, Verzijl JM, Simons KA, van der Pol WS, et al. Risk factors for the development of adverse drug events in hospitalized patients. Pharm World Sci2000;22:62–6.10.1023/A:1008721321016Suche in Google Scholar
30. Tryding N, Tufvesson C, Sonntag O. Drug effects in clinical chemistry, 7th ed. Stockholm: AB Realtryck, 1996.Suche in Google Scholar
31. Salway JG. Drug-test interactions handbook, 1st ed. London: Chapman and Hall Medical, 1990.Suche in Google Scholar
32. Kroll MH, Elin RJ. Interference with clinical laboratory analyses. Clin Chem1994;40:1996–2005.10.1093/clinchem/40.11.1996Suche in Google Scholar
33. Kailajarvi M, Takala T, Gronroos P, Tryding N, Viikari J, Irjala K, et al. Reminders of drug effects on laboratory test results. Clin Chem2000;46:1395–400.10.1093/clinchem/46.9.1395Suche in Google Scholar
34. Marshall T, Williams KM. Total protein determination in urine: aminoglycoside interference. Clin Chem2003;49:202–3.10.1373/49.1.202Suche in Google Scholar
35. Gronroos P, Irjala K, Heiskanen J, Torniainen K, Forsstrom JJ. Using computerized individual medication data to detect drug effects on clinical laboratory tests. Scand J Clin Lab Invest Suppl1995;222:31–6.10.3109/00365519509088448Suche in Google Scholar
36. Schiff GD, Aggarwal HC, Kumar S, McNutt RA. Prescribing potassium despite hyperkalemia: medication errors uncovered by linking laboratory and pharmacy information systems. Am J Med2000;109:494–7.10.1016/S0002-9343(00)00546-5Suche in Google Scholar
37. Juurlink DN, Mamdani MM, Lee DS, Kopp A, Austin PC, Laupacis A, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med2004;351:543–51.10.1056/NEJMoa040135Suche in Google Scholar PubMed
38. Schiff GD, Kim S, Krosnjar N, Wisniewski MF, Bult J, Fogelfeld L, et al. Missed hypothyroidism diagnosis uncovered by linking laboratory and pharmacy data. Arch Intern Med2005;165:574–7.10.1001/archinte.165.5.574Suche in Google Scholar PubMed
39. Chertow GM, Lee J, Kuperman GJ, Burdick E, Horsky J, Seger DL, et al. Guided medication dosing for inpatients with renal insufficiency. J Am Med Assoc2001;286:2839–44.10.1001/jama.286.22.2839Suche in Google Scholar PubMed
40. Raebel MA, Lyons EE, Chester EA, Bodily MA, Kelleher JA, Long CL, et al. Improving laboratory monitoring at initiation of drug therapy in ambulatory care: a randomized trial. Arch Intern Med2005;165:2395–401.10.1001/archinte.165.20.2395Suche in Google Scholar PubMed
41. Meyboom R, Gribnau F, Hekster Y, de Koning G, Egberts A. Characteristics of topics in pharmacovigilance in The Netherlands. Clin Drug Invest1996;12:207–19.10.2165/00044011-199612040-00006Suche in Google Scholar
42. Simon SR, Andrade SE, Ellis JL, Nelson WW, Gurwitz JH, Lafata JE, et al. Baseline laboratory monitoring of cardiovascular medications in elderly health maintenance organization enrollees. J Am Geriatr Soc2005;53:2165–9.10.1111/j.1532-5415.2005.00498.xSuche in Google Scholar PubMed
43. Raebel MA, McClure DL, Simon SR, Chan KA, Feldstein AC, Gunter MJ, et al. Frequency of serum creatinine monitoring during allopurinol therapy in ambulatory patients. Ann Pharmacother2006;40:386–91.10.1345/aph.1G589Suche in Google Scholar PubMed
44. Derijks HJ, De Koning GH, Mantel-Teeuwisse AK, Egberts AC. Limited adherence to safety instructions in drug leaflets. Br J Clin Pharmacol2002;54:678–9.10.1046/j.1365-2125.2002.01701.xSuche in Google Scholar PubMed PubMed Central
45. Goettsch WG, Yin DD, Alemao E, Klungel OH, Stalenhoef AF, Herings RM. Statins are less effective in common daily practice among patients with hypercholesterolemia: the REALITY-PHARMO study. Curr Med Res Opin2004;20:1025–33.10.1185/030079904125004114Suche in Google Scholar PubMed
46. Kane-Gill SL, Dasta JF, Schneider PJ, Cook CH. Monitoring abnormal laboratory values as antecedents to drug-induced injury. J Trauma2005;59:1457–62.10.1097/01.ta.0000196009.42623.50Suche in Google Scholar PubMed
47. Warkentin TE, Roberts RS, Hirsh J, Kelton JG. An improved definition of immune heparin-induced thrombocytopenia in postoperative orthopedic patients. Arch Intern Med2003;163:2518–24.10.1001/archinte.163.20.2518Suche in Google Scholar PubMed
48. Strom BL, Carson JL. Use of automated databases for pharmacoepidemiology research. Epidemiol Rev1990;12:87–107.10.1093/oxfordjournals.epirev.a036064Suche in Google Scholar PubMed
49. Stricker BH, Psaty BM. Detection, verification, and quantification of adverse drug reactions. Br Med J2004;329:44–7.10.1136/bmj.329.7456.44Suche in Google Scholar PubMed PubMed Central
50. Movig KL, Leufkens HG, Lenderink AW, Egberts AC. Validity of hospital discharge International Classification of Diseases (ICD) codes for identifying patients with hyponatremia. J Clin Epidemiol2003;56:530–5.10.1016/S0895-4356(03)00006-4Suche in Google Scholar
51. Schneeweiss S, Avorn J. A review of uses of health care utilization databases for epidemiologic research on therapeutics. J Clin Epidemiol2005;58:323–37.10.1016/j.jclinepi.2004.10.012Suche in Google Scholar
52. Zwetsloot-Schonk JH, Snitker P, Vandenbroucke JP, Bakker AR. Using hospital information systems for clinical epidemiological research. Med Inform (Lond)1989;14:53–62.10.3109/14639238909010879Suche in Google Scholar
53. Wijk R, van Wesel AC, Thomas AA, Rijksen G, van Solinge WW. Ex vivo analysis of aberrant splicing induced by two donor site mutations in PKLR of a patient with severe pyruvate kinase deficiency. Br J Haematol2004;125:253–63.10.1111/j.1365-2141.2004.04895.xSuche in Google Scholar
54. Potter JD. Epidemiology informing clinical practice: from bills of mortality to population laboratories. Nat Clin Pract Oncol2005;2:625–34.10.1038/ncponc0359Suche in Google Scholar
55. Maitland-van der Zee AH, de Boer A, Leufkens HG. The interface between pharmacoepidemiology and pharmacogenetics. Eur J Pharmacol2000;410:121–30.10.1016/S0014-2999(00)00810-4Suche in Google Scholar
©2007 by Walter de Gruyter Berlin New York
Artikel in diesem Heft
- CCLM: Bringing advances in laboratory medicine to the “New World”
- Diagnostic approach to inherited bleeding disorders
- Linking laboratory and medication data: new opportunities for pharmacoepidemiological research
- Association between polymorphisms of ACE, B2AR, ANP and ENOS and cardiovascular diseases: a community-based study in the Matsu area
- Anti-thyroid-stimulating hormone receptor antibodies determined by second-generation assay
- Serum levels of granulocyte colony-stimulating factor (G-CSF) and macrophage colony-stimulating factor (M-CSF) in pancreatic cancer patients
- Surrogate markers of insulin resistance in assessing individuals with new categories “prehypertension” and “prediabetes”
- Evaluation of pre-analytical, demographic, behavioural and metabolic variables on fibrinolysis and haemostasis activation markers utilised to assess hypercoagulability
- Hyperhomocysteinaemia and immune activation in patients with cancer
- The effect of homocysteine reduction by B-vitamin supplementation on inflammatory markers
- Lipid peroxidation in Down syndrome caused by regular trisomy 21, trisomy 21 by Robertsonian translocation and mosaic trisomy 21
- Pregnancy-associated plasma protein A in dialysis patients
- L-Cysteine supplementation prevents exercise-induced alterations in human erythrocyte membrane acetylcholinesterase and Na+,K+-ATPase activities
- Assessment of homocysteine, neopterin and nitric oxide levels in Behcet's disease
- Increased adenosine deaminase in hydatidiform mole
- Classification tree analysis for the discrimination of pleural exudates and transudates
- External quality assessment of hemoglobin A2 measurement: data from an Italian pilot study with fresh whole blood samples and commercial HPLC systems
- Comparison of four commercial quantitative HIV-1 assays for viral load monitoring in clinical daily routine
- Interchangeability of measurements of CA 19-9 in serum with four frequently used assays: an update
- Analytical validation of the new version of the Liaison N-Tact PTH assay
- Validation of an automated sensitive immunoassay for quantitation of cytokines in the sputum of cystic fibrosis patients
- Strong interference of hemoglobin concentration on CSF total protein measurement using the trichloroacetic acid precipitation method
- Correction of patient results for Beckman Coulter LX-20 assays affected by interference due to hemoglobin, bilirubin or lipids: a practical approach
- Acquiring a measurement system within the framework of standard ISO 15189
- Six Sigma and laboratory consultation
- ESR or LSRB, that is the question!
- Reply to the Letter written by Hardeman
- Natriuretic peptides. The hormones of the heart
Artikel in diesem Heft
- CCLM: Bringing advances in laboratory medicine to the “New World”
- Diagnostic approach to inherited bleeding disorders
- Linking laboratory and medication data: new opportunities for pharmacoepidemiological research
- Association between polymorphisms of ACE, B2AR, ANP and ENOS and cardiovascular diseases: a community-based study in the Matsu area
- Anti-thyroid-stimulating hormone receptor antibodies determined by second-generation assay
- Serum levels of granulocyte colony-stimulating factor (G-CSF) and macrophage colony-stimulating factor (M-CSF) in pancreatic cancer patients
- Surrogate markers of insulin resistance in assessing individuals with new categories “prehypertension” and “prediabetes”
- Evaluation of pre-analytical, demographic, behavioural and metabolic variables on fibrinolysis and haemostasis activation markers utilised to assess hypercoagulability
- Hyperhomocysteinaemia and immune activation in patients with cancer
- The effect of homocysteine reduction by B-vitamin supplementation on inflammatory markers
- Lipid peroxidation in Down syndrome caused by regular trisomy 21, trisomy 21 by Robertsonian translocation and mosaic trisomy 21
- Pregnancy-associated plasma protein A in dialysis patients
- L-Cysteine supplementation prevents exercise-induced alterations in human erythrocyte membrane acetylcholinesterase and Na+,K+-ATPase activities
- Assessment of homocysteine, neopterin and nitric oxide levels in Behcet's disease
- Increased adenosine deaminase in hydatidiform mole
- Classification tree analysis for the discrimination of pleural exudates and transudates
- External quality assessment of hemoglobin A2 measurement: data from an Italian pilot study with fresh whole blood samples and commercial HPLC systems
- Comparison of four commercial quantitative HIV-1 assays for viral load monitoring in clinical daily routine
- Interchangeability of measurements of CA 19-9 in serum with four frequently used assays: an update
- Analytical validation of the new version of the Liaison N-Tact PTH assay
- Validation of an automated sensitive immunoassay for quantitation of cytokines in the sputum of cystic fibrosis patients
- Strong interference of hemoglobin concentration on CSF total protein measurement using the trichloroacetic acid precipitation method
- Correction of patient results for Beckman Coulter LX-20 assays affected by interference due to hemoglobin, bilirubin or lipids: a practical approach
- Acquiring a measurement system within the framework of standard ISO 15189
- Six Sigma and laboratory consultation
- ESR or LSRB, that is the question!
- Reply to the Letter written by Hardeman
- Natriuretic peptides. The hormones of the heart