Abstract
With the rapid changes in the legalization of cannabis in the U.S., there is an urgent need to understand clinical outcomes and processes of care among patients who use cannabis, particularly among patients with chronic pain who are high utilizers of cannabis. Electronic health records (EHRs) are a common and convenient mechanism for examining processes of care; however, there is not an indication for cannabis use that does not meet criteria for a diagnostic disorder. We used urine drug test (UDT) results identified through EHRs to identify patients with confirmed cannabis use. We developed and tested an algorithm to identify outcomes of UDT results for cannabis because there is wide variability in reporting methodology, including in multi-site health systems. Among all patients receiving care in the Department of Veterans Affairs (VA) who were prescribed long-term opioid therapy for chronic pain, we identified a random sample who completed UDT for cannabis. Through an iterative process, we developed an algorithm to identify UDT cannabis results. Manual review of EHR data was conducted to verify accuracy of UDT results. The final UDT algorithm correctly identified 99% of cannabis positive UDT results and 100% of cannabis negative UDT results among 200 randomly sampled patients. Study findings suggest a high degree of accuracy for using an algorithm to identify samples of patients with positive cannabis UDT results across multiple institutions with disparate UDT reporting practices. The methodology for testing this algorithm is feasible and may be applied to other multi-site health systems.
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Funding
Research reported in this manuscript was supported by grant 034083 from the National Institute on Drug Abuse of the National Institutes of Health and 1I01HX001583 from the VA Health Services Research & Development service. The work was also supported by resources from the VA Health Services Research and Development-funded Center to Improve Veteran Involvement in Care at the VA Portland Health Care System (CIN 13–404).
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No author reports having any potential conflict of interest with this study. The content of this manuscript is solely the responsibility of the authors and does not represent the official views of the Department of Veterans Affairs or the National Institute on Drug Abuse.
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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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This article is part of the Topical Collection on Transactional Processing Systems
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Morasco, B.J., Shull, S.E., Adams, M.H. et al. Development of an Algorithm to Identify Cannabis Urine Drug Test Results within a Multi-Site Electronic Health Record System. J Med Syst 42, 163 (2018). https://doi.org/10.1007/s10916-018-1021-7
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DOI: https://doi.org/10.1007/s10916-018-1021-7