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Abstract Details
Administrative coding in electronic health care record-based research of NAFLD: an expert panel consensus statement
Hepatology. 2021 Jan 23. doi: 10.1002/hep.31726. Online ahead of print.
Hannes Hagström123, Leon A Adams4, Alina M Allen5, Christopher D Byrne67, Yoosoo Chang8, Henning Grønbaek9, Mona Ismail1011, Peter Jepsen9, Fasiha Kanwal12, Jennifer Kramer12, Jeffrey V Lazarus13, Michelle T Long14, Rohit Loomba15, Philip N Newsome1617, Ian A Rowe18, Seungho Ryu819, Jörn M Schattenberg20, Marina Serper21, Nick Sheron22, Tracey G Simon2324, Elliot B Tapper25, Sarah Wild26, Vincent Wai-Sun Wong27, Yusuf Yilmaz2829, Shira Zelber-Sagi30, Fredrik Åberg3132
Author information
1Division of Hepatology, Department of Upper GI, Karolinska University Hospital, Stockholm, Sweden.
2Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
3Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
4Medical School, University of Western Australia, Perth, Australia.
5Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
6Nutrition and Metabolism, Faculty of Medicine, University of Southampton, Southampton, UK.
7Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, Tremona Road, Southampton, UK.
8Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
9Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
10Division of Gastroenterology, Department of Internal Medicine, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia.
11College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
12Baylor College of Medicine and Michael E. DeBakey VA Medical Center, Houston TX, USA.
13Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.
14Department of Medicine, Section of Gastroenterology, Boston University School of Medicine, Boston, MA, USA.
15NAFLD Research Center, Division of Gastroenterology and Epidemiology, University of California at San Diego, La Jolla, California, USA.
16National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, UK, Southampton.
17Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, UK, Birmingham.
18Leeds Institute for Medical Research, University of Leeds, UK, Leeds.
19Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
20Metabolic Liver Research Program, I. Department of Medicine, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.
21Division of Gastroenterology and Hepatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
22Foundation for Liver Research, London, UK.
23Division of Gastroenterology and Hepatology, Massachusetts General Hospital, Boston, Massachusetts, USA.
24Harvard Medical School, Boston, MA, USA.
25Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, USA.
26Usher Institute, University of Edinburgh, UK, Southampton.
27Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
28Liver Research Unit, Institute of Gastroenterology, Marmara University, Turkey, Istanbul.
29Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey.
30School of Public Health, University of Haifa, Haifa, Israel.
31Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, Finland.
32University of Helsinki, Helsinki, Finland.
Abstract
Background and aims: Electronic health record (EHR)-based research allows the capture of large amounts of data, which is necessary in nonalcoholic fatty liver disease (NAFLD), where the risk of clinical liver outcomes is generally low. The lack of consensus on which International Classification of Disease (ICD) codes should be used as exposures and outcomes limits comparability and generalizability of results across studies. We aimed to establish consensus among a panel of experts on ICD codes that could become the reference standard and provide guidance around common methodological issues.
Approach and results: Researchers with an interest in EHR-based NAFLD research were invited to collectively define which administrative codes are most appropriate for documenting exposures and outcomes. We used a modified Delphi approach to reach consensus on several commonly encountered methodological challenges in the field. After two rounds of revision, a high level of agreement (>67%) was reached on all items considered. Full consensus was achieved on a comprehensive list of administrative codes to be considered for inclusion and exclusion criteria in defining exposures and outcomes in EHR-based NAFLD research. We also provide suggestions on how to approach commonly encountered methodological issues and identify areas for future research.
Conclusions: This expert panel consensus statement can help harmonize and improve generalizability of EHR-based NAFLD research.