Evidence map›Paper›PMID 31736189›Full record

ArticlePharmacoepidemiology and drug safety2020

Identifying monoclonal gammopathy of undetermined significance in electronic health data.

Mara Meyer Epstein, Cassandra Saphirak, Yanhua Zhou, Candace LeBlanc, Alan G Rosmarin, Arlene Ash, Sonal Singh, Kimberly Fisher, Brenda M Birmann, Jerry H Gurwitz

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Pharmacoepidemiology and drug safety, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Mara Meyer EpsteinThe Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA.ORCID 0000-0001-7906-4856
Cassandra SaphirakThe Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA.
Yanhua ZhouThe Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA.
Candace LeBlancReliant Medical Group, Worcester, MA, USA.
Alan G RosmarinUpToDate, Waltham, MA, USA.
Arlene AshDepartment of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
Sonal SinghThe Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA.
Kimberly FisherThe Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA.
Brenda M BirmannChanning Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Jerry H GurwitzThe Meyers Primary Care Institute, a joint venture of Reliant Medical Group, Fallon Health, and the University of Massachusetts Medical School, Worcester, MA, USA.

Funding

University of Massachusetts Center for Clinical and Translational ScienceKL2TR001455 · NCATS · UNIV OF MASSACHUSETTS MED SCH WORCESTER · PI KIEFE, CATARINA I. · 2015 to 2024
$5.0M
University of Massachusetts Center for Clinical and Translational ScienceTL1TR001454 · NCATS · UNIV OF MASSACHUSETTS MED SCH WORCESTER · PI LEWIS, BRIAN C · 2015 to 2024
$3.6M
Patient-Perceived Breakdowns in Care: Informing Physician Responses and Improvements in Healthcare DeliveryK08HS024596 · AHRQ · UNIV OF MASSACHUSETTS MED SCH WORCESTER · PI FISHER, KIMBERLY · 2016 to 2020
$738k
Defining Monoclonal Gammopathy of Unknown Significance in Automated Health DataR03CA199383 · NCI · UNIV OF MASSACHUSETTS MED SCH WORCESTER · PI EPSTEIN, MARA MEYER · 2016 to 2017
$96k
AHRQ HHS K08 HS024596NCATS NIH HHS KL2TR001454NCATS NIH HHS KL2 TR001455NCATS NIH HHS TL1 TR001454NCI NIH HHS R03 CA199383NCRR NIH HHS
6 · The paper itself

Abstract

purposeMonoclonal gammopathy of undetermined significance (MGUS) is a prevalent yet largely asymptomatic precursor to multiple myeloma. Patients with MGUS must undergo regular surveillance and testing, with few known predictors of progression. We developed an algorithm to identify MGUS patients in electronic health data to facilitate large-scale, population-based studies of this premalignant condition.

methodsWe developed a four-step algorithm using electronic health record and health claims data from men and women aged 50 years or older receiving care from a large, multispecialty medical group between 2007 and 2015. The case definition required patients to have at least two MGUS ICD-9 diagnosis codes within 12 months, at least one serum and/or urine protein electrophoresis and one immunofixation test, and at least one in-office hematology/oncology visit. Medical charts for selected cases were abstracted then adjudicated independently by two physicians. We assessed algorithm validity by positive predictive value (PPV).

resultsWe identified 833 people with at least two MGUS diagnosis codes; 429 (52%) met all four algorithm criteria. We randomly selected 252 charts for review, including 206 from patients meeting all four algorithm criteria. The PPV for the 206 algorithm-identified charts was 76% (95% CI, 70%-82%). Among the 49 cases deemed to be false positives (24%), 33 were judged to have multiple myeloma or another lymphoproliferative condition, such as lymphoma.

conclusionsWe developed a simple algorithm that identified MGUS cases in electronic health data with reasonable accuracy. Inclusion of additional steps to eliminate cases with malignant disease may improve algorithm performance.

Indexed as

AlgorithmsAgedAged, 80 and overDisease ProgressionElectronic Health RecordsFemaleHumansMaleMassachusettsMiddle AgedMonoclonal Gammopathy of Undetermined SignificanceMultiple MyelomaPredictive Value of Testsadministrative claimsalgorithmselectronic health recordshealth caremonoclonal gammopathy of undetermined significancepharmacoepidemiology

Identifiers

PMID31736189
PMCPMC7365702

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.