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Do you vape? Leveraging electronic health records to assess clinician documentation of electronic nicotine delivery system use among adolescents and adults - PubMed

Do you vape? Leveraging electronic health records to assess clinician documentation of electronic nicotine delivery system use among adolescents and adults

Kelly C Young-Wolff et al. Prev Med. 2017 Dec.

Abstract

Use of electronic nicotine delivery systems (ENDS) has increased substantially over the past decade. However, unlike smoking, which is systematically captured by clinicians through routine screening and discrete documentation fields in the electronic health record (EHR), unknown is the extent to which clinicians are documenting patients' use of ENDS. Data were gathered from medical visits with patients aged 12 and older (N=9,119; 55% male) treated in a large, integrated healthcare system. We used natural language processing to assess the incidence rates of clinician documentation of patients' ENDS use in unstructured tobacco comments in the EHR, and the words most frequently documented in relation to ENDS, from 2006-2015. ENDS documentation in the EHR increased dramatically over time (from 0.01 to 9.5 per 10,000 patients, p<0.0001), particularly among adults aged 18-24 and 25-44. Most prevalent were "e-cig," "electronic cigarettes", and "vape," with much variation in spelling and phrasing of these words. Records of adolescent and young adult patients were more likely to contain the word "vape", and less likely to have "e-cig" and "electronic cigarette" than records of adults (ps<0.0001). The relatively low observed number of patients with ENDS terms in the EHR suggested vast under documentation. While healthcare providers are increasingly documenting patients' use of ENDS in the EHR, overall documentation rates remain low. Discrete EHR fields for standard screening and documentation of ENDS that reflect the language used by patients would provide more complete longitudinal population-level surveillance of ENDS use and its association with short- and long-term health outcomes.

Keywords: Adolescents; Clinicians; E-cigarettes; Electronic health record; Electronic nicotine delivery systems; Integrated healthcare; Natural language processing; Semantics; Vaping.

Copyright © 2017 Elsevier Inc. All rights reserved.

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Conflict of interest statement

All other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1

Annual Unadjusted Incidence Rate of ENDS Use Documentation by Patient Age Group, Kaiser Permanente Northern California, 2006–2015. Notes (Singh et al., 2016). All rate ratios were significant at p < 0.0001 except for the rate changes from 2010 to 2011 and 2014–2015 among 18–24 year olds, the change from 2009–2010 among those ages 65+, and the change from 2006–2008 among patients ages 25–44. (King et al., 2015) The crude rate ratio for an age group can be calculated by dividing the rate in one year (e.g., 2015) by the rate in the previous year (2014). However, reported rate ratios in the text were calculated with adjustment for race and sex, resulting in different estimates for certain time points.

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