cprd: an introduction to the clinical practice research datalink in … · 2016. 7. 14. · what is...
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CPRD: An introduction to the Clinical
Practice Research Datalink in
CambridgeRupert Payne
What is CPRD?
• Governmental, not-for-profit research service
• Funded by NIHR and MHRA
• VAMP Research (1987) GPRD (1993) CPRD (2012)
• Provides anonymous general practice health records for public health
research, with linkage to additional non-primary care data
• University has annual institutional license to online access of data
• Managed through Primary Care Unit
• Funded by specific projects with additional support from BRC
Primary care data collection
• Primary care data collected from Vision GP clinical software
• Data are recorded as part of routine clinical practice
• Coded data, free text
• Practices assessed for quality of data recording
• Feedback provided to GPs to improve/standardise recording
• Data anonymised at practice, then uploaded to CPRD servers for
processing and validation
The CPRD population
• 7% sample of UK population
• 5 million “active” patients
• 674 Vision practices
• Mean practice list size:
CPRD=8400, UK=6600
CPRD population 2014
UK population
Overview of primary care data
• Patient – demographics, registration
• Practice – region, collection information
• Consultations – date, duration
• Clinical – diagnoses, administrative details
• Therapy – electronic prescribing
• Immunisation – vaccination details
• Referrals – to secondary care
• Tests – lab results, other measures
• Staff – staff type
Surveys
Biological samples
Embedded trials
Linkages to other data
• Admitted Patient Care Hospital Episode Statistics (HES)
• Outpatient Hospital Episode Statistics (HES)
• Death Registration Data (Office for National Statistics, ONS)
• Cancer registry data (Public Health England)
• Cardiovascular registry data (Myocardial Ischaemia National Audit Project, MINAP)
• On-going linkage: e.g. mental health (MHMDS), HES A&E, digital imaging
• …plus additional bespoke linkages if required
How well are things recorded?
Herrett, Int J Epidemiol 2015
CPRD clients
• Academia
• Pharmaceutical industry
• Government
Research that can be done with CPRD
Medication and devices
• Drug utilisation, compliance and persistence
• Pharmacovigilance
• Pharmacoepidemiology
• Pharmacoeconomics
• Life cycle planning
• Licence extension research
Health care interventions
• Comparative effectiveness research
Outcomes
• Clinical outcomes
• Patient Reported Outcomes
Public health research
• Epidemiology
• Health Services research
• Risk management research
• Risk-benefit research
• Risk score development
Clinical trials
• Randomisation at point of care
• Phase 3 and 4 trials
CPRD observational data resources and services
• Disease and drug registers
• Pan European and US data
Publications using CPRD
Cambridge work using CPRD
• Work led by Autism Research Centre
• Women with polycystic ovarian syndrome, and their children, have a
greater prevalence of autism
OR 1.90
(1.32-2.72)
OR 1.58
(1.27-1.98)
Baron-Cohen, unpublished data
Cambridge work using CPRD
• MPhil student project
• Association between
service utilisation and
multimorbidity in persons
with dementia
Browne, unpublished data
Cambridge work using CPRD
• Long-term outcomes of survivors of critical care
• Novel linkage of CPRD and ICNARC-CMP
• Pharmacoeconomics of iron salts utilisation
• Supporting novel drug development
• Medication use in end of life care patients
Challenges of using CPRD
• Messy data • Code lists
diabetes codes
• Big data
Independent Scientific Advisory Committee (ISAC)
“To consider and provide advice to MHRA on … all research projects which
propose the use of data obtained from the Clinical Practice Research
Datalink”
• Advises on medical, statistical, epidemiological and methodological aspects
• Ensures no governance concerns
• All protocols to use data must be first approved by ISAC
• Protocols should adhere to IPSE Good Pharmacoepidemiology Practices
• Some studies may also require other committee approval (e.g. HRA
Confidentiality Advisory Group, HSCIC Data Access Advisory Group)
Core CPRD team
Rupert
Payne
Duncan
Edwards
James
BrimicombeAmelia
Harshfield
Kirsty
Rhodes
Overview of primary care data
• Patient – demographics, registration
• Practice – region, collection information
• Consultations – date, duration
• Clinical – diagnoses, administrative details
• Therapy – electronic prescribing
• Immunisation – vaccination details
• Referrals – to secondary care
• Tests – lab results, other measures
• Staff – staff type
Structure of the data
Structure of the data
Linkages to other data
• Admitted Patient Care Hospital Episode Statistics (HES)
• Outpatient Hospital Episode Statistics (HES)
• Death Registration Data (Office for National Statistics, ONS)
• Cancer registry data (Public Health England)
• Cardiovascular registry data (Myocardial Ischaemia National Audit Project, MINAP)
• On-going linkage: e.g. mental health (MHMDS), HES A&E, digital imaging
• …plus additional bespoke linkages if required
Patient table
Patient table
Consultation table
Clinical table
Clinical table: an example
patid eventdate constype consid medcode staffid adid
1 25-Oct-55 3 546 15797 0 0
1 21-Aug-60 3 546 16944 0 0
1 01-May-65 3 546 2134 0 0
1 01-May-65 3 546 4725 0 0
1 12-Jul-65 3 546 4725 0 0
1 05-Mar-70 1 546 6029 0 0
1 27-Jul-75 1 546 5991 0 0
1 18-Nov-82 1 546 2957 0 0
1 14-Mar-83 4 546 10523 0 0
1 14-Mar-83 1 546 4604 0 0
1 26-Jun-91 6 546 19239 2267 0
1 26-Jun-91 6 542 107 2267 0
1 07-Jun-93 3 543 6573 0 160
1 13-Nov-12 2 550 12947 4628267 163
1 13-Nov-12 2 550 25969 4628267 0
Clinical table: an example
patid eventdate constype consid medcode staffid adid
1 13-Nov-12 2 550 3 4628267 161
1 13-Nov-12 2 550 2 4628267 162
1 15-Nov-12 6 551 6677 29267 0
1 29-Nov-12 6 552 19239 2267 0
1 18-Jan-13 6 554 34 2267 0
1 16-May-13 6 555 106217 2267 0
1 17-May-13 6 556 97061 2267 0
1 16-Sep-13 3 557 6089 23267 0
1 19-Nov-13 6 559 6677 3668267 0
1 22-Nov-13 6 560 6677 2267 0
1 10-Dec-13 6 562 1649 29267 0
1 30-Dec-13 6 563 6677 3668267 0
1 21-Jan-14 3 566 7622 17267 0
1 23-Jan-14 6 567 106221 2267 0
1 23-Jan-14 6 567 106221 2267 0
Clinical table: an example
patid eventdate constype consid medcode staffid adid
1 25-Oct-55 3 546 15797 0 0
1 21-Aug-60 3 546 16944 0 0
1 01-May-65 3 546 2134 0 0
1 01-May-65 3 546 4725 0 0
1 12-Jul-65 3 546 4725 0 0
1 05-Mar-70 1 546 6029 0 0
1 27-Jul-75 1 546 5991 0 0
1 18-Nov-82 1 546 2957 0 0
1 14-Mar-83 4 546 10523 0 0
1 14-Mar-83 1 546 4604 0 0
1 26-Jun-91 6 546 19239 2267 0
1 26-Jun-91 6 542 107 2267 0
1 07-Jun-93 3 543 6573 0 160
1 13-Nov-12 2 550 12947 4628267 163
1 13-Nov-12 2 550 25969 4628267 0
administration
intervention
diagnosis
symptom
examination
Defining your population
• Denominator files
• Define tool
Challenges of using CPRD
• Messy data • Code lists
diabetes codes
• Big data
Challenges of using CPRD – Code Lists??
• Messy data • Code lists
diabetes codes
• Big data
Challenges of using CPRD – Code Lists??
The Art of creating Code Lists...
diabetes codes
Challenges of using CPRD – Code Lists??
(Some) list of Diabetes Codes...
Challenges of using CPRD – Code Lists??
A list of Diabetes Codes
Challenges of using CPRD – Code Lists??
A list of Diabetes Codes
Challenges of using CPRD – Code Lists??
Simple use of a Code List...
Data Manager
(JB)
GP (DE)
Statistician
(KR)
Finance
Coordinator
(TM)
CPRD team
coordinator (AH)
CPRD team lead
(RP)
CPRD Team Functions
• Promote CPRD use e.g. via occasional
presentations for the unit, FAQ via the website,
answer brief queries via the group coordinator, and
open access to any to bring problems to a
fortnightly CPRD-group meeting.
• Assist non-CPRD research e.g. by undertaking
rapid feasibility counts for grants – e.g.
“approximately how many patients with melanoma
and diabetes could we find in the east of England
and how feasible is it to identify them?”
• Provide brief advice and support to groups
wishing to produce CPRD research (but not able
undertake database design, full statistical analysis
or condition phenotyping for them UNLESS
funding has been arranged for required support
and data – BUT we can advise on what is likely to
be required).*
• Coordinate CPRD work within the unit, e.g.
ensuring database design, statistical analysis and
phenotyping strategies are stored, cited and
disseminated.
• Share best practice externally with other
universities using CPRD, and other big data
sources used at Cambridge, e.g. Biobank.
• Ensure sustainable funding.
• Produce publications with increasing quantity,
quality and impact.
• Develop statistical and IT methods and tools to
use CPRD efficiently and in novel ways
Quarterly outcome
measures
Finance
A measure or report on
financial sustainability (to be
developed by finance
coordinator).
Research Activity
1. ISAC applications made
2. ISAC approvals
3. Analyses in progress
4. Writing in progress
5. Submitted papers
6. Publications
Unit Capability
Amplification
1. Rapid feasibility counts
(RDS outcome also).
2. Number of the people in
the unit who have
contributed/are
contributing to a CPRD-
based research study.