Identifying potential biases in code sequences in primary care electronic healthcare records: a retrospective cohort study of the determinants of code frequency

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Abstract
Objectives To determine whether the frequency of diagnostic codes for long-term conditions (LTCs) in primary care electronic healthcare records (EHRs) is associated with (1) disease coding incentives, (2) General Practice (GP), (3) patient sociodemographic characteristics and (4) calendar year of diagnosis. Design Retrospective cohort study. Setting GPs in England from 2015 to 2022 contributing to the Clinical Practice Research Datalink Aurum dataset. Participants All patients registered to a GP with at least one incident LTC diagnosed between 1 January 2015 and 31 December 2019. Primary and secondary outcome measures The number of diagnostic codes for an LTC in (1) the first and (2) the second year following diagnosis, stratified by inclusion in the Quality and Outcomes Framework (QOF) financial incentive programme. Results 3 113 724 patients were included, with 7 723 365 incident LTCs. Conditions included in QOF had higher rates of annual coding than conditions not included in QOF (1.03 vs 0.32 per year, pConclusions The frequency of diagnostic codes for newly diagnosed LTCs is influenced by factors including patient sociodemographics, disease inclusion in QOF, GP practice and the impact of the COVID-19 pandemic. Natural language processing or other methods using temporally ordered code sequences should account for these factors to minimise potential bias.
Funding Information
  • Engineering and Physical Sciences Research Council (EP/N014529/1)
  • Wellcome Trust (N/A)
  • National Institute for Health and Care Research (N/A)

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