Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records
Background There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research. Aims This study aimed to validate proxy tools for the sh...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2024-01-01
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| Series: | BJPsych Open |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472423006233/type/journal_article |
| _version_ | 1827390118378340352 |
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| author | Álvaro López-Díaz Fernanda Jazmín Palermo-Zeballos Luis Gutierrez-Rojas Luis Alameda Francisco Gotor-Sánchez-Luengo Nathalia Garrido-Torres Johann Métrailler Livia Alerci Vincent Bonnarel Pablo Cano-Domínguez Elma Avanesi-Molina Miguel Soto-Ontoso Rocio Torrecilla-Olavarrieta Leticia Irene Muñoz-Manchado Pedro Torres-Hernández Fermín González-Higueras Juan Luis Prados-Ojeda Mario Herrera-Cortés José Miguel Meca-García Rafael Manuel Gordillo-Urbano Cristina Sánchez-Robles Tomás Delgado-Durán María Felipa Soriano-Peña Philippe Golay Philippe Conus Benedicto Crespo-Facorro Miguel Ruiz-Veguilla |
| author_facet | Álvaro López-Díaz Fernanda Jazmín Palermo-Zeballos Luis Gutierrez-Rojas Luis Alameda Francisco Gotor-Sánchez-Luengo Nathalia Garrido-Torres Johann Métrailler Livia Alerci Vincent Bonnarel Pablo Cano-Domínguez Elma Avanesi-Molina Miguel Soto-Ontoso Rocio Torrecilla-Olavarrieta Leticia Irene Muñoz-Manchado Pedro Torres-Hernández Fermín González-Higueras Juan Luis Prados-Ojeda Mario Herrera-Cortés José Miguel Meca-García Rafael Manuel Gordillo-Urbano Cristina Sánchez-Robles Tomás Delgado-Durán María Felipa Soriano-Peña Philippe Golay Philippe Conus Benedicto Crespo-Facorro Miguel Ruiz-Veguilla |
| author_sort | Álvaro López-Díaz |
| collection | DOAJ |
| description | Background
There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research.
Aims
This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery–Åsberg Depression Rating Scale (MADRS-6).
Method
A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation.
Results
The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set.
Conclusions
The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings.
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| first_indexed | 2024-03-08T16:46:47Z |
| format | Article |
| id | doaj.art-21c18626848145fdb261488ecce37fa9 |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-03-08T16:46:47Z |
| publishDate | 2024-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-21c18626848145fdb261488ecce37fa92024-01-05T08:48:28ZengCambridge University PressBJPsych Open2056-47242024-01-011010.1192/bjo.2023.623Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health recordsÁlvaro López-Díaz0https://orcid.org/0000-0002-6478-4807Fernanda Jazmín Palermo-Zeballos1Luis Gutierrez-Rojas2Luis Alameda3Francisco Gotor-Sánchez-Luengo4Nathalia Garrido-Torres5Johann Métrailler6Livia Alerci7Vincent Bonnarel8Pablo Cano-Domínguez9Elma Avanesi-Molina10Miguel Soto-Ontoso11Rocio Torrecilla-Olavarrieta12Leticia Irene Muñoz-Manchado13Pedro Torres-Hernández14Fermín González-Higueras15Juan Luis Prados-Ojeda16Mario Herrera-Cortés17José Miguel Meca-García18Rafael Manuel Gordillo-Urbano19Cristina Sánchez-Robles20Tomás Delgado-Durán21María Felipa Soriano-Peña22Philippe Golay23Philippe Conus24Benedicto Crespo-Facorro25Miguel Ruiz-Veguilla26Mental Health Clinical Management Unit, Virgen Macarena University Hospital, Seville, Spain; Translational Psychiatry Research Group (PsyNal), Seville Biomedical Research Centre (IBiS), Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Seville, Spain; Department of Psychiatry, School of Medicine, University of Seville, Spain; and First-Episode Psychosis Research Network of Andalusia (Red PEPSur), SpainMental Health Clinical Management Unit, Virgen Macarena University Hospital, Seville, Spain; and First-Episode Psychosis Research Network of Andalusia (Red PEPSur), SpainFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; Mental Health Clinical Management Unit, San Cecilio University Hospital, Granada, Spain; Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Spain; and Department of Psychiatry, University of Granada, SpainService of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, Switzerland; and Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UKDepartment of Psychiatry, School of Medicine, University of Seville, Spain; First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen del Rocío University Hospital, Seville, SpainTranslational Psychiatry Research Group (PsyNal), Seville Biomedical Research Centre (IBiS), Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Seville, Spain; First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen del Rocío University Hospital, Seville, SpainService of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, SwitzerlandService of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, SwitzerlandService of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, SwitzerlandFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen de la Victoria University Hospital, Málaga, SpainFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen de la Victoria University Hospital, Málaga, SpainFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Torrecárdenas University Hospital, Almería, SpainFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Jerez University Hospital, Cádiz, SpainFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Jerez University Hospital, Cádiz, SpainFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Jaén University Hospital, SpainFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Jaén University Hospital, SpainFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Reina Sofía University Hospital, Córdoba, SpainFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Reina Sofía University Hospital, Córdoba, SpainFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Poniente University Hospital, Almería, SpainFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Infanta Margarita Hospital, Córdoba, SpainFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Juan Ramón Jiménez Hospital, Huelva, SpainFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Juan Ramón Jiménez Hospital, Huelva, SpainFirst-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, San Agustín University Hospital, Linares, SpainService of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, SwitzerlandService of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP), Lausanne University Hospital and University of Lausanne, SwitzerlandTranslational Psychiatry Research Group (PsyNal), Seville Biomedical Research Centre (IBiS), Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Seville, Spain; Department of Psychiatry, School of Medicine, University of Seville, Spain; First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen del Rocío University Hospital, Seville, SpainTranslational Psychiatry Research Group (PsyNal), Seville Biomedical Research Centre (IBiS), Spain; Spanish Network for Research in Mental Health, Carlos III Institute (CIBERSAM, ISCIII), Seville, Spain; Department of Psychiatry, School of Medicine, University of Seville, Spain; First-Episode Psychosis Research Network of Andalusia (Red PEPSur), Spain; and Mental Health Clinical Management Unit, Virgen del Rocío University Hospital, Seville, SpainBackground There is a lack of standardised psychometric data in electronic health record (EHR)-based research. Proxy measures of symptom severity based on patients' clinical records may be useful surrogates in mental health EHR research. Aims This study aimed to validate proxy tools for the short versions of the Positive and Negative Syndrome Scale (PANSS-6), Young Mania Rating Scale (YMRS-6) and Montgomery–Åsberg Depression Rating Scale (MADRS-6). Method A cross-sectional, multicentre study was conducted in a sample of 116 patients with first-episode psychosis from 12 public hospitals in Spain. Concordance between PANSS-6, YMRS-6 and MADRS-6 scores and their respective proxies was evaluated based on information from EHR clinical notes, using a variety of statistical procedures, including multivariate tests to adjust for potential confounders. Bootstrapping techniques were used for internal validation, and an independent cohort from the Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne, Switzerland) for external validation. Results The proxy versions correlated strongly with their respective standardised scales (partial correlations ranged from 0.75 to 0.84) and had good accuracy and discriminatory power in distinguishing between patients in and not in remission (percentage of patients correctly classified ranged from 83.9 to 91.4% and bootstrapped optimism-corrected area under the receiver operating characteristic curve ranged from 0.76 to 0.89), with high interrater reliability (intraclass correlation coefficient of 0.81). The findings remained robust in the external validation data-set. Conclusions The proxy instruments proposed for assessing psychotic and affective symptoms by reviewing EHR provide a feasible and reliable alternative to traditional structured psychometric procedures, and a promising methodology for real-world practice settings. https://www.cambridge.org/core/product/identifier/S2056472423006233/type/journal_articleSchizophreniapsychosisaffective disorderselectronic health recordsclinical assessment tool |
| spellingShingle | Álvaro López-Díaz Fernanda Jazmín Palermo-Zeballos Luis Gutierrez-Rojas Luis Alameda Francisco Gotor-Sánchez-Luengo Nathalia Garrido-Torres Johann Métrailler Livia Alerci Vincent Bonnarel Pablo Cano-Domínguez Elma Avanesi-Molina Miguel Soto-Ontoso Rocio Torrecilla-Olavarrieta Leticia Irene Muñoz-Manchado Pedro Torres-Hernández Fermín González-Higueras Juan Luis Prados-Ojeda Mario Herrera-Cortés José Miguel Meca-García Rafael Manuel Gordillo-Urbano Cristina Sánchez-Robles Tomás Delgado-Durán María Felipa Soriano-Peña Philippe Golay Philippe Conus Benedicto Crespo-Facorro Miguel Ruiz-Veguilla Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records BJPsych Open Schizophrenia psychosis affective disorders electronic health records clinical assessment tool |
| title | Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records |
| title_full | Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records |
| title_fullStr | Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records |
| title_full_unstemmed | Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records |
| title_short | Proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records |
| title_sort | proxy measures for the assessment of psychotic and affective symptoms in studies using electronic health records |
| topic | Schizophrenia psychosis affective disorders electronic health records clinical assessment tool |
| url | https://www.cambridge.org/core/product/identifier/S2056472423006233/type/journal_article |
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