Skip to main content
construction release_alert
Scholars@Duke will be undergoing maintenance April 11-15. Some features may be unavailable during this time.
cancel
Journal cover image

Controlling for Informed Presence Bias Due to the Number of Health Encounters in an Electronic Health Record.

Publication ,  Journal Article
Goldstein, BA; Bhavsar, NA; Phelan, M; Pencina, MJ
Published in: Am J Epidemiol
December 1, 2016

Electronic health records (EHRs) are an increasingly utilized resource for clinical research. While their size allows for many analytical opportunities, as with most observational data there is also the potential for bias. One of the key sources of bias in EHRs is what we term informed presence-the notion that inclusion in an EHR is not random but rather indicates that the subject is ill, making people in EHRs systematically different from those not in EHRs. In this article, we use simulated and empirical data to illustrate the conditions under which such bias can arise and how conditioning on the number of health-care encounters can be one way to remove this bias. In doing so, we also show when such an approach can impart M bias, or bias from conditioning on a collider. Finally, we explore the conditions under which number of medical encounters can serve as a proxy for general health. We apply these methods to an EHR data set from a university medical center covering the years 2007-2013.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Am J Epidemiol

DOI

EISSN

1476-6256

Publication Date

December 1, 2016

Volume

184

Issue

11

Start / End Page

847 / 855

Location

United States

Related Subject Headings

  • Selection Bias
  • Reproducibility of Results
  • Humans
  • Health Status
  • Health Services
  • Epidemiology
  • Epidemiologic Research Design
  • Electronic Health Records
  • Diabetes Mellitus
  • Depression
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Goldstein, B. A., Bhavsar, N. A., Phelan, M., & Pencina, M. J. (2016). Controlling for Informed Presence Bias Due to the Number of Health Encounters in an Electronic Health Record. Am J Epidemiol, 184(11), 847–855. https://doi.org/10.1093/aje/kww112
Goldstein, Benjamin A., Nrupen A. Bhavsar, Matthew Phelan, and Michael J. Pencina. “Controlling for Informed Presence Bias Due to the Number of Health Encounters in an Electronic Health Record.Am J Epidemiol 184, no. 11 (December 1, 2016): 847–55. https://doi.org/10.1093/aje/kww112.
Goldstein BA, Bhavsar NA, Phelan M, Pencina MJ. Controlling for Informed Presence Bias Due to the Number of Health Encounters in an Electronic Health Record. Am J Epidemiol. 2016 Dec 1;184(11):847–55.
Goldstein, Benjamin A., et al. “Controlling for Informed Presence Bias Due to the Number of Health Encounters in an Electronic Health Record.Am J Epidemiol, vol. 184, no. 11, Dec. 2016, pp. 847–55. Pubmed, doi:10.1093/aje/kww112.
Goldstein BA, Bhavsar NA, Phelan M, Pencina MJ. Controlling for Informed Presence Bias Due to the Number of Health Encounters in an Electronic Health Record. Am J Epidemiol. 2016 Dec 1;184(11):847–855.
Journal cover image

Published In

Am J Epidemiol

DOI

EISSN

1476-6256

Publication Date

December 1, 2016

Volume

184

Issue

11

Start / End Page

847 / 855

Location

United States

Related Subject Headings

  • Selection Bias
  • Reproducibility of Results
  • Humans
  • Health Status
  • Health Services
  • Epidemiology
  • Epidemiologic Research Design
  • Electronic Health Records
  • Diabetes Mellitus
  • Depression