Enhancing gout management by creating a register using automated queries in electronic health records
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Objective
To develop an automatic gout register to improve gout management.
Methods
We analysed the electronic health records (EHR) of all patients >18 years old from a tertiary academic hospital (2013-2022) based on six criteria: International Classification of Diseases 10 (ICD-10) gout diagnosis, urate-lowering therapy (ULT) prescription, uric acid crystal in joint aspiration and gout-related terms in problem lists, clinical or imaging reports. We assessed the positive and negative predictive value (PPV and NPV) of the query by chart reviews.
Results
Of 2,110,902 out- and inpatients, 10,289 had at least one criterion for gout. The combination of joint aspiration OR diagnostic in the problem list OR ≥ 2 other criteria created a register of 5,138 patients, with a PPV of 92.4% (95%CI: 88.5 to 95.0), and an NPV of 94.3% (95%CI: 91.9 to 96.0). PPV and NPV were similar amongst outpatients and inpatients. Incidence was 2.9 per 1000 person-year and dropped by 30% from the COVID-19 pandemic onward. Patients with gout were on average 71.2 years old (SD 14.9), mainly male (76.5%), overweight (69.5%) and polymorbid (mean number of comorbidities of 3, IQR 1-5). More than half (57.4%) had received a urate lowering treatment, 6.7% had a gout that led to a hospitalisation or ≥2 flares within a year, and 32.9% received a rheumatology consultation.
Conclusion
An automatic EHR-based gout register is feasible, valid and could be used to evaluate and improve gout management. Interestingly, the register uncovered a marked underdiagnosis or underreporting of gout since the COVID-19 pandemic.
Key messages
What is already known on this topic?
Gout is the most prevalent inflammatory arthritis, but it remains undertreated despite affordable and effective treatment options.
Quantifying this undertreatment and detecting its causes and risk factors to pilot quality improvement initiative requires an extensive register of gout patients.
What this study adds?
This is the first automatic EHR-based gout register, allowing frequent, inexpensive, and sustainable updates.
The automated queries show high positive and negative predictive values to identify gout patients.
How this study might affect research, practice or policy?
This register can facilitate the assessment of the adequacy of gout management and the monitoring of quality indicators following improvement projects, or change in policies
It provides an easy platform for cohort studies or adaptive trials
Its methodology is reproducible, facilitating the establishment of gout or other disease registers within different EHR systems
