An Exploratory Study of the Use of the Electronic Health Records of Hypertensive Patients to Support the Primary Prevention of Stroke in Shanghai

Tingting Yang; Fen Li; Bifan Zhu; Yuqian Chen; Duo Chen; Changying Wang; Zhiying Hou; Jiajie Xu; Shuwei Gu; Jiefeng Liu; Zhuochun Wu; Ying Wang; Chunlin Jin

doi:10.2147/RMHP.S269535

An Exploratory Study of the Use of the Electronic Health Records of Hypertensive Patients to Support the Primary Prevention of Stroke in Shanghai

Risk Manag Healthc Policy. 2020 Sep 28:13:1781-1789. doi: 10.2147/RMHP.S269535. eCollection 2020.

Authors

Tingting Yang^#¹, Fen Li^#², Bifan Zhu², Yuqian Chen², Duo Chen², Changying Wang², Zhiying Hou², Jiajie Xu², Shuwei Gu³, Jiefeng Liu⁴, Zhuochun Wu¹, Ying Wang¹, Chunlin Jin²

Affiliations

¹ School of Public Health/ Key Laboratory of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China, Fudan University, Shanghai, People's Republic of China.
² Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People's Republic of China.
³ Jiangxi University of Traditional Chinese Medicine, School of Economics and Management, Nanchang, Jiangxi, People's Republic of China.
⁴ Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, People's Republic of China.

^# Contributed equally.

Abstract

Background: The value of identifying and targeting population demographics at high risk of stroke based on patient-reported outcomes (PROs) with electronic health records (EHRs) in Shanghai is largely undiscovered.

Aim: To test the hypothesis that establishing an evidence-based support system composed of PROs integrated with EHRs could be effective at identifying individuals at high risk of suffering from stroke.

Methods: The patients included in this study joined the hypertensive patient management system from 2014 to 2018. We merged the Hypertension Patients Management Database and the Diabetes Mellitus Patients Management Database of Shanghai Jiading district, then kept the hypertension patients with or without diabetes. We subsequently performed a screen analysis utilizing EHRs to target the population with any risk factor for stroke, namely, hypertension, diabetes mellitus, obesity, smoking and physical inactivity. We also calculated the distribution of each risk factor and the combinations of risk factors.

Results: In the Jiading District of Shanghai, 46,580 hypertensive patients with complete baseline information joined the hypertensive patient management system from 2014 to 2018. The majority of the patients were aged above 60 years old. Physical inactivity (83.24%), smoking (24.07%), diabetes (16.87%), and obesity (12.23%) were highly prevalent in hypertensive participants. Approximately 4377 patients were diagnosed with hypertension exclusively, accounting for 9.70% of the total number of patients in this study. Meanwhile, approximately 52.47% of the patients were diagnosed with two concurrent risk factors, and 38.13% of the patients had hypertension, meaning that 17,762 patients could be labeled as the high-risk population for stroke according to the criteria established by the National Stroke Screening Survey.

Conclusion: Our exploratory findings demonstrate the feasibility of pinpointing and targeting populations at high risk of stroke using the EHRs of hypertensive patients.

Keywords: EHRs; electronic health records; hypertension; stroke risk factors.

Grants and funding

This work was support by three grants, Shanghai Municipal Health Commission 2018YQ51, the National Natural Science Foundation of China (71673055), Shanghai Municipal Science and Technology Major Project (No.2018SHZDZX01), and ZJLab. The funder had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.