Indicators of inappropriate tumour marker use through the mining of electronic health records

• Published in: Journal of evaluation in clinical practice 2017-08, Vol.23 (4), p.895-902
• Main Authors: Gion, Massimo, Cardinali, Giulia, Trevisiol, Chiara, Zappa, Marco, Rainato, Giulia, Fabricio, Aline S.C.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; alpha-Fetoproteins - analysis; Antigens; Antigens, Tumor-Associated, Carbohydrate - blood; appropriateness; Biomarkers; Biomarkers, Tumor - blood; Cancer; Carcinoembryonic Antigen - blood; Data Mining; Diagnostic tests; Electronic health records; Electronic Health Records - statistics & numerical data; Female; Humans; indicators; Italy; Male; Middle Aged; Neoplasms - blood; overuse; primary care; Prostate-Specific Antigen - blood; Sex Factors; tumour markers; Unnecessary Procedures - statistics & numerical data; Young Adult
• ISSN: 1356-1294; 1365-2753
• DOI: 10.1111/jep.12754

Rationale, aims, and objectives Although the issue of monitoring appropriateness of tumour markers (TMs) request in outpatients remains crucial, proper indicators are still demanding. The present study developed and explored indicators of inappropriate TM ordering in outpatients through the data mining of electronic health records (EHRs). Methods Carcinoembryonic antigen (CEA), alfa‐fetoprotein (AFP), carbohydrate antigen (CA)125, CA15.3, CA19.9, and prostate‐specific antigen (PSA) ordered in outpatients during a year were examined by mining EHRs of a Local Health Authority in Italy. Evidence‐based criteria were used to develop performance indicators. Demographic and clinical information associated with TM orders were examined. Results A total of 80 813 TMs were ordered in 52 536 outpatients (1.54 markers/patient). Indicators related to disease codes, gender, age, and TM repetitions were developed, and their application showed that (1) CA15.3 and CEA are prevalently requested in patients with cancer (79.2% and 65.6%) whereas the other TMs are largely requested also in patients without cancer; (2) requests of PSA in women and of CA125 or CA15.3 in men are negligible; (3) although requests in people older than 80 years are relevant (16.4% of total), the highest rate of request of all markers occurs in patients aged 40 to 79 years; (4) CA15.3 and CEA are mainly requested in cancer cases between 50 and 79 years and AFP, CA19.9, and CA125 in those between 60 and 69 years; (5)