Operationalizing Asthma Analytic Plan using OMOP Common Data Model Elias Brandt, BS, BA1; Bethany Kwan, PhD, MSPH2; Marion Sills, MD, MPH2,3, Barbara Yawn MD, MSc, FAAFP4, Monica Federico, MD3, Patrick

Hosokawa, MS2 and Lisa Schilling, MD, MSPH2 1AAFP National Research Network, 2University of Colorado School of Medicine, 3Children’s Hospital Colorado, 4Olmsted Medical Center

OBJECTIVE

• To operationalize an analytic plan designed to model the association between practices’ medical home characteristics and asthma control in children and adults using a database of existing electronic health data structured according to the OMOP V4 Common Data Model.

OPERATIONALIZATION OF ASTHMA ANALYTIC VARIABLES

• Step 1: Define cohort of patients for extraction from standardized data • Create list of subjects identified based on Age, Gender, Visits, and Diagnoses • Simplified example for illustration:

• Step 2: Extract standardized data elements related to list of patients

• Simplified example for illustration:

CONCLUSION

• Secondary use of existing electronic health data from multiple healthcare organizations requires: • Harmonization of local data structure with a

common data model. • Harmonization of local source values with a common

vocabulary • Centralized mapping of local source values allows

standardization across organizations • Data conforming to the OMOP CDM V4 can be used to

operationalize observational CER studies. • Implications for Policy, Delivery, or Practice

• Though EHRs all use different backend databases, they can be harmonized to a CDM for research purposes. We recommend that the EHR industry move toward having a standard data model so that the initial harmonization step is less cumbersome.

SAFTINET ASTHMA

STUDY • The Scalable Architecture for Federated

Translational Inquiries Network (SAFTINet) was designed to federate electronic health data to support quality improvement and comparative effectiveness research (CER).

• Federated databases include existing administrative, clinical (e.g., from electronic health records; EHRs), Medicaid claims and enrollment data, and patient-reported data collected during routine clinical care, which have been harmonized to the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) Version 4.

• SAFTINet Asthma Study • Prospective, longitudinal cohort study, • Utilizing survey methodologies and secondary

use of structured Clinical, administrative, and claims data.

• Population • Adults and children with asthma cared for in

participating primary care practices in SAFTINet.

OMOP V4 COMMON DATA MODEL TWO-STEP STANDARDIZATION OF

SOURCE DATA

• Source data includes: • EHR administrative and clinical data • Medicaid claims and enrollment data, • Patient-reported data collected during routine clinical care

• Working with each partner individually ensured that their data could conform to the OMOP V4 CDM and that the data required for the study was available before extracting data for secondary use.

• Step 1: Structure of source data from each partner harmonized to the (OMOP) CDM Version 4

• Step 2: Values in source data from each partner harmonized to the OMOP V4 Vocabulary

Source Field Applied Rule Destination Field Data Type

PersonRowKey person_source_value String (50) / Required

‘CDW’ derived x_data_source_type String (20) / Required

NULL Not available medicaid_id_number String (50)

PersonYearOfBirth year_of_birth Number(4) / Required

Derived Derived from PersonDateOfBirth month_of_birth Number (2)

PersonDateOfBirth day_of_birth Number (2)

SexName gender_source_value String (50)

RaceName race_source_value String (50)

EthnicityName ethnicity_source_value String (50)

Partner Ethnicity Source Values Standardized Concept ID Standardized Concept Name

CINA_Cherokee E: Unknown / Not Reported 0 No matching concept

Denver Health UNKNOWN 0 No matching concept

CACHIE Not Reported 0 No matching concept

CINA_Cherokee E: Hispanic or Latino 38003563 Hispanic or Latino

Denver Health Hispanic 38003563 Hispanic or Latino

CACHIE Hispanic/Latino 38003563 Hispanic or Latino

CINA_Cherokee E: Not Hispanic or Latino 38003564 Not Hispanic or Latino

CACHIE Non-Hispanic (Other) 38003564 Not Hispanic or Latino

OMOP VOCABULARIES

OMOP Standard Vocabulary Used in CDM Field

SNOMED-CT condition_concept_id

RxNorm drug_concept_id

LOINC observation_concept_id

SNOMED-CT observation_concept_id

CMS Place of Service place_of_service_concept_id

CPT-4 procedure_concept_id

HCPCS procedure_concept_id

ICD-9-Procedure procedure_concept_id

CMS Specialty specialty_concept_id

CDC Race race_concept_id

Ethnicity ethnicity_concept_id

HL7 Administrative Sex gender_concept_id

• Step 3: Transform extracted data elements into asthma variables • Simplified example for illustration:

Asthma Analysis Plan Cohort Definition:

Child w/ asthma (Active patient):

Implementation using OMOP CDM 4:

Select subjects where: OMOP Table

Between 2 and 17 years as of 01-July-2012

year_of_birth > 1997 and year_of_birth < 2010

Or year_of_birth = 1997 and month_of_birth >= 7

Or year_of_birth = 2010 and month_of_birth < 7 x_demographic

Two diagnosis codes for asthma (493.XX) 6- year

period of available EHR data (01-Jan-2008 – 31-Dec-

2013)

condition_concept_id in (4141622, 4232595, 312950,

252341, 259055, 4119298, 252658, 261048, 254980,

256448, 256448, 256448, 256448, 443801, 313236,

4112831, 317009, 256716, 257581) AND

x_condition_update_date > 1/1/2008 condition_occurrence

Asthma variable domain: Asthma Variable Logic for Extraction Query

Pull records of patients identified in cohort from Person table

Select * from person where person_id in [cohort definition

query]

Pull selected records from observation

Select * from observation WHERE person_id in [cohort definition

query] AND observation_concept_id in [list of concept ids

related to ACT]

Subject Demographics

Asthma Control Test (Patient-

Reported Outcome)

pt_id

pt_child

pt_gender

pt_race

pt_ethn

pt_birthdate

pt_age

pt_id

act_date

act_score

act_control

Asthma Variable Logic for Operationalization from OMOP V4 CDM

pt_birthdate Concatenate month_of_birth, day_of_birth, and year_of_birth

pt_age Calculate age as of 7/1/12 using pt_birthdate

pt_child Set to "1" if pt_age < 18

asthma_dxcode

Set to "1" if condition_concept_id in ((4141622, 4232595, 312950, 252341,

259055, 4119298, 252658, 261048, 254980, 256448, 256448, 256448, 256448,

443801, 313236, 4112831, 317009, 256716, 257581)

exacerbation_type1

Oral steroids or IM/IV steroids exposure

Set to "1" if [drug_exposure].[drug_concept_id] in (list of concept ids for

oral steroids or IM/IV steroids)

exacerbation_type3

Administration of inhaled beta-agonist medication at an outpatient visit

Set to "1" if procedure_occurrence.procedure_concept_id in (list of

concept_ids for administration of beta-agonists) OR

(drug_exposure.drug_concept_id in (list of concept ids for beta agonists

AND drug_type_concept_id = 38000179)

exacerbation_type4

An asthma-related emergency department visit or hospitalization with

asthma listed as the primary or secondary diagnosis

Set to "1" if condition_concept_id in ((4141622, 4232595, 312950, 252341,

259055, 4119298, 252658, 261048, 254980, 256448, 256448, 256448, 256448,

443801, 313236, 4112831, 317009, 256716, 257581) AND

condition_type_concept_id in (38000215, 38000216) AND

visit.occurrence.visit_place_of_service = 8870