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The feasibility of using of electronic health records to inform clinical decision making for community-onset urinary tract infection in England

Rockenschaub, Patrick; (2021) The feasibility of using of electronic health records to inform clinical decision making for community-onset urinary tract infection in England. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Urinary tract infections (UTIs) are a major source of morbidity, yet differentiating UTI from other conditions and choosing the right treatment remains challenging. Using case studies from English primary and secondary care, this thesis investigates the potential use of electronic health records (EHR) - i.e., data recorded as part of routine care - to aid the diagnosis and management of community-onset UTI. I start by introducing sources of uncertainty in diagnosing UTI (Chapter 1) and review how EHRs have previously been used to study UTIs (Chapter 2). In Chapter 3, I discuss EHR sources available to study UTIs in England. In Chapter 4, I explore how EHRs from primary care can be used to guide antibiotic prescribing for UTI, by evaluating harms of delaying treatment in key patient groups. In Chapters 5 and 6, I explore the use of EHR data as a diagnostic tool to guide antibiotic de-escalation in patients with suspected UTI in the emergency department (ED). Cases of community-onset UTI could be identified in both primary and secondary care data but case definitions relied heavily on coarse diagnostic codes. A lack of information on patients' acute health status, clinical observations (e.g., urine dipstick tests), and reasons for antibiotic prescribing resulted in heterogeneous study cohorts, which likely confounded estimated effects of antibiotic treatment in primary care. In secondary care, early prediction of bacteriuria to guide antibiotic prescribing decisions in the ED proved promising, but model performance varied greatly by patient mix and variable definitions. Better recording of clinical information and a combination of retrospective EHR analysis with prospective cohorts and qualitative approaches will be required to derive actionable insights on UTI. Results based solely on currently available EHR data need to be interpreted carefully.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: The feasibility of using of electronic health records to inform clinical decision making for community-onset urinary tract infection in England
Event: UCL (University College London)
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: opyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0) Licence (https://creativecommons.org/licenses/by/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10131376
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