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Research ArticleOriginal Research

Monitoring Suicidal Patients in Primary Care Using Electronic Health Records

Heather D. Anderson, Wilson D. Pace, Elias Brandt, Rodney D. Nielsen, Richard R. Allen, Anne M. Libby, David R. West and Robert J. Valuck
The Journal of the American Board of Family Medicine January 2015, 28 (1) 65-71; DOI: https://doi.org/10.3122/jabfm.2015.01.140181
Heather D. Anderson
the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
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Wilson D. Pace
the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
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Elias Brandt
the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
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Rodney D. Nielsen
the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
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Richard R. Allen
the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
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Anne M. Libby
the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
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David R. West
the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
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Robert J. Valuck
the Department of Clinical Pharmacy, University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora (HDA, AML, RJV); the Department of Family Medicine, University of Colorado School of Medicine, Aurora (HDA, WDP, AML, DRW, RJV); the Department of Epidemiology, University of Colorado School of Public Health, Aurora (HDA, RJV); the American Academy of Family Physicians, Leawood, KS (WDP, EB); the Institute of Cognitive Science, University of Colorado, Boulder (RDN); the Department of Computer Science, University of Colorado, Boulder (RDN); and Peak Statistical Services, Evergreen, CO (RRA).
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    Figure 1.

    Cohorts included in the current study. From the original cohort of 61,464 patients with a new diagnosis of depression from 14 practices, a cohort of 32,385 patients with a new episode of depression was available from a subset of 8 practices willing to provide history of present illness (HPI) data for this study. From this cohort, we identified 15,761 patients with HPI data that was processed through a natural language processing algorithm (HPI subset); 1,013 patients with the 9th item from the 9-item Patient Health Questionnaire (PHQ-9) recorded in their electronic health record (PHQ-9 subset); 16,289 patients with HPI data or PHQ-9 item 9 data (HPI or PHQ-9 subset); and 485 patients with both HPI and PHQ-9 data (both HPI and PHQ-9 subset).

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    Table 1. Demographic Characteristics of Patients Included in the Overall Cohort and the 4 Subsets (1998 to 2011)
    CharacteristicsOverall Cohort (n = 32,385)HPI Subset (n = 15,761)PHQ-9 Subset (n = 1,013)HPI or PHQ-9 Subset (n = 16,289)Both HPI & PHQ-9 Subset (n = 485)
    Female sex6867676767
    Age (years), mean (median), range61 (65), 13–9860.4 (63), 13–9854.2 (55), 15–9660.2 (17.9), 13–9853.1 (53), 15–94
    Age group
        Adolescent (13–18 years old)1.11.10.71.11.2
        Adult (19–64 years old)48.450.568.751.169.3
        Older adult (≥65 years old)50.548.430.6.47.829.5
    • Data are percentages unless otherwise indicated.

    • HPI, history of present illness; PHQ-9, 9-item Patient Health Questionnaire.

    • View popup
    Table 2. Concordance Between Indications of Suicidal Ideation According to the Specified Source* and Indications According to International Classification of Diseases, 9th Revision, Codes
    HPI (n = 15,761)PHQ-9 (n = 1,013)HPI or PHQ-9 (n = 16,289)Both HPI and PHQ-9 (n = 485)
    Suicidal ideation indicated by specified source1,025 (6.5)85 (8.4)1,098 (6.7)12 (2.5)
        Corresponding ICD-9 code included30 (3)4 (5)34 (3.1)0 (0)
        κ Statistic0.0360.0680.04—
    • Data are n (%).

    • ↵* Source corresponds to the column headings: history of present illness [HPI] notes field; item 9 of the 9-item Patient Health Questionnaire [PHQ-9]; HPI notes field or PHQ-9 item 9; both the HPI notes field and PHQ-9 item 9.

    • ICD-9, International Classification of Diseases, 9th Revision.

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The Journal of the American Board of Family     Medicine: 28 (1)
The Journal of the American Board of Family Medicine
Vol. 28, Issue 1
January-February 2015
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Monitoring Suicidal Patients in Primary Care Using Electronic Health Records
Heather D. Anderson, Wilson D. Pace, Elias Brandt, Rodney D. Nielsen, Richard R. Allen, Anne M. Libby, David R. West, Robert J. Valuck
The Journal of the American Board of Family Medicine Jan 2015, 28 (1) 65-71; DOI: 10.3122/jabfm.2015.01.140181

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Monitoring Suicidal Patients in Primary Care Using Electronic Health Records
Heather D. Anderson, Wilson D. Pace, Elias Brandt, Rodney D. Nielsen, Richard R. Allen, Anne M. Libby, David R. West, Robert J. Valuck
The Journal of the American Board of Family Medicine Jan 2015, 28 (1) 65-71; DOI: 10.3122/jabfm.2015.01.140181
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Keywords

  • Electronic Health Records
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