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Boyd AD, Gonzalez-Guarda R, Lawrence K, Patil CL, Ezenwa MO, O’Brien EC, Paek H, Braciszewski JM, Adeyemi O, Cuthel AM, Darby JE, Zigler CK, Ho PM, Faurot KR, Staman KL, Leigh JW, Dailey DL, Cheville A, Del Fiol G, Knisely MR, Grudzen CR, Marsolo K, Richesson RL, Schlaeger JM. Potential bias and lack of generalizability in electronic health record data: reflections on health equity from the National Institutes of Health Pragmatic Trials Collaboratory. J Am Med Inform Assoc 2023; 30:1561-1566. [PMID: 37364017 PMCID: PMC10436149 DOI: 10.1093/jamia/ocad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Embedded pragmatic clinical trials (ePCTs) play a vital role in addressing current population health problems, and their use of electronic health record (EHR) systems promises efficiencies that will increase the speed and volume of relevant and generalizable research. However, as the number of ePCTs using EHR-derived data grows, so does the risk that research will become more vulnerable to biases due to differences in data capture and access to care for different subsets of the population, thereby propagating inequities in health and the healthcare system. We identify 3 challenges-incomplete and variable capture of data on social determinants of health, lack of representation of vulnerable populations that do not access or receive treatment, and data loss due to variable use of technology-that exacerbate bias when working with EHR data and offer recommendations and examples of ways to actively mitigate bias.
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Affiliation(s)
- Andrew D Boyd
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Katharine Lawrence
- Department of Population Health, New York University Grossman School of Medicine, New York City, New York, USA
| | - Crystal L Patil
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Miriam O Ezenwa
- University of Florida College of Nursing, Gainesville, Florida, USA
| | - Emily C O’Brien
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Hyung Paek
- Biostatistics (Health Informatics), Yale University, New Haven, Connecticut, USA
| | | | - Oluwaseun Adeyemi
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - Allison M Cuthel
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, New York City, New York, USA
| | - Juanita E Darby
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - P Michael Ho
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Keturah R Faurot
- Department of Physical Medicine and Rehabilitation, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Karen L Staman
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Jonathan W Leigh
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Dana L Dailey
- Physical Therapy, St. Ambrose University, Davenport, Iowa, USA
- Department of Physical Therapy and Rehabilitation Science Department, University of Iowa, Iowa City, Iowa, USA
| | - Andrea Cheville
- Mayo Clinic Comprehensive Cancer Center, Rochester, Minnesota, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Corita R Grudzen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Keith Marsolo
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rachel L Richesson
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Judith M Schlaeger
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
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