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Validation of Veterans Affairs Electronic Medical Record Smoking Data Among Iraq- and Afghanistan-Era Veterans.

Publication ,  Journal Article
Calhoun, PS; Wilson, SM; Hertzberg, JS; Kirby, AC; McDonald, SD; Dennis, PA; Bastian, LA; Dedert, EA; VA Mid-Atlantic MIRECC Workgroup, ; Beckham, JC
Published in: J Gen Intern Med
November 2017

BACKGROUND: Research using the Veterans Health Administration (VA) electronic medical records (EMR) has been limited by a lack of reliable smoking data. OBJECTIVE: To evaluate the validity of using VA EMR "Health Factors" data to determine smoking status among veterans with recent military service. DESIGN: Sensitivity, specificity, area under the receiver-operating curve (AUC), and kappa statistics were used to evaluate concordance between VA EMR smoking status and criterion smoking status. PARTICIPANTS: Veterans (N = 2025) with service during the wars in Iraq/Afghanistan who participated in the VA Mid-Atlantic Post-Deployment Mental Health (PDMH) Study. MAIN MEASURES: Criterion smoking status was based on self-report during a confidential study visit. VA EMR smoking status was measured by coding health factors data entries (populated during automated clinical reminders) in three ways: based on the most common health factor, the most recent health factor, and the health factor within 12 months of the criterion smoking status data collection date. KEY RESULTS: Concordance with PDMH smoking status (current, former, never) was highest when determined by the most commonly observed VA EMR health factor (κ = 0.69) and was not significantly impacted by psychiatric status. Agreement was higher when smoking status was dichotomized: current vs. not current (κ = 0.73; sensitivity = 0.84; specificity = 0.91; AUC = 0.87); ever vs. never (κ = 0.75; sensitivity = 0.85; specificity = 0.90; AUC = 0.87). There were substantial missing Health Factors data when restricting analyses to a 12-month period from the criterion smoking status date. Current smokers had significantly more Health Factors entries compared to never or former smokers. CONCLUSIONS: The use of computerized tobacco screening data to determine smoking status is valid and feasible. Results indicating that smokers have significantly more health factors entries than non-smokers suggest that caution is warranted when using the EMR to select cases for cohort studies as the risk for selection bias appears high.

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

November 2017

Volume

32

Issue

11

Start / End Page

1228 / 1234

Location

United States

Related Subject Headings

  • Veterans Health
  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Smoking
  • Middle Aged
  • Male
  • Iraq War, 2003-2011
  • Humans
  • General & Internal Medicine
 

Citation

APA
Chicago
ICMJE
MLA
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Calhoun, P. S., Wilson, S. M., Hertzberg, J. S., Kirby, A. C., McDonald, S. D., Dennis, P. A., … Beckham, J. C. (2017). Validation of Veterans Affairs Electronic Medical Record Smoking Data Among Iraq- and Afghanistan-Era Veterans. J Gen Intern Med, 32(11), 1228–1234. https://doi.org/10.1007/s11606-017-4144-5
Calhoun, Patrick S., Sarah M. Wilson, Jeffrey S. Hertzberg, Angela C. Kirby, Scott D. McDonald, Paul A. Dennis, Lori A. Bastian, Eric A. Dedert, Eric A. VA Mid-Atlantic MIRECC Workgroup, and Jean C. Beckham. “Validation of Veterans Affairs Electronic Medical Record Smoking Data Among Iraq- and Afghanistan-Era Veterans.J Gen Intern Med 32, no. 11 (November 2017): 1228–34. https://doi.org/10.1007/s11606-017-4144-5.
Calhoun PS, Wilson SM, Hertzberg JS, Kirby AC, McDonald SD, Dennis PA, et al. Validation of Veterans Affairs Electronic Medical Record Smoking Data Among Iraq- and Afghanistan-Era Veterans. J Gen Intern Med. 2017 Nov;32(11):1228–34.
Calhoun, Patrick S., et al. “Validation of Veterans Affairs Electronic Medical Record Smoking Data Among Iraq- and Afghanistan-Era Veterans.J Gen Intern Med, vol. 32, no. 11, Nov. 2017, pp. 1228–34. Pubmed, doi:10.1007/s11606-017-4144-5.
Calhoun PS, Wilson SM, Hertzberg JS, Kirby AC, McDonald SD, Dennis PA, Bastian LA, Dedert EA, VA Mid-Atlantic MIRECC Workgroup, Beckham JC. Validation of Veterans Affairs Electronic Medical Record Smoking Data Among Iraq- and Afghanistan-Era Veterans. J Gen Intern Med. 2017 Nov;32(11):1228–1234.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

November 2017

Volume

32

Issue

11

Start / End Page

1228 / 1234

Location

United States

Related Subject Headings

  • Veterans Health
  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Smoking
  • Middle Aged
  • Male
  • Iraq War, 2003-2011
  • Humans
  • General & Internal Medicine