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Analysis of hospitalizations in the population with diabetes with EHRead tools
Valoración de hospitalizaciones en pacientes con diabetes con herramientas de sistemas de información clínica
David E. Barajas-Galindo
Corresponding author
dabarajas@saludcastillayleon.es

Corresponding author.
, Begoña Pintor-de la Maza, Isidoro Cano-Rodríguez, María D. Ballesteros-Pomar
Sección de Endocrinología y Nutrición, Complejo Asistencial Universitario de León, León, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Diabetes mellitus &#40;DM&#41; is a common cause of morbidity and mortality throughout the world&#46; According to data from 2012&#44; 13&#46;8&#37; of the Spanish population suffers from T2DM&#44; although only 7&#46;8&#37; have been diagnosed&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> By comparison&#44; the prevalence of T1DM is estimated at 0&#46;08&#8211;0&#46;2&#37;&#44; which represents 1&#8211;1&#46;5&#37; of all patients with diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Patients with DM have a two to six times higher risk of hospitalisation in relation to their underlying disease compared to patients without diabetes&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> This means that one out of every six patients admitted to Spanish hospitals has been diagnosed with diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Understanding the main causes and risk factors for hospitalisation is important as some may be modifiable&#44; which could benefit patients by reducing the risk of admission&#44; and have a beneficial impact on society with a reduction in associated costs&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The recent availability of big data analytics tools of clinical information has facilitated the identification of these possible risk factors&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The &#8220;Electronic Health Records&#8221; &#40;EHR&#41; systems consist of the systematised collection of patient health information stored electronically in a digital format&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This generated information is incorporated into tools such as Savana Manager&#174; using &#8220;EHRead&#8221; technology&#44; which enables the natural language of the EHRs to be extracted&#44; thus guaranteeing confidentiality and enabling its analysis with artificial intelligence&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> We are therefore plunging into the era of &#8220;Big Data&#8221;&#44; which allows the routine gathering of large amounts of data to be used&#44; overcoming the limitations of traditional research at a much lower cost&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In order to assess the prevalence of hospitalised patients with diabetes and to identify the most common reasons for admission to our hospital in this population&#44; after approval by our centre&#39;s Ethics Committee we used the Savana Manager&#169;tool to select patients with a hospitalisation report in which &#8220;diabetes&#8221;&#44; &#8220;type 2 diabetes mellitus&#8221; or &#8220;type 1 diabetes mellitus&#8221; were encoded either as the principal or secondary diagnosis or in personal history&#44; in a hospital discharge report for a five-year period&#44; from 1 January 2012 to 31 December 2016&#46; Patients under 18 years of age at the time of hospitalisation were excluded&#46; The patient inclusion flow chart is summarised in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In the analysis period&#44; 139&#44;688 hospitalisation episodes were recorded in adult patients with an associated discharge report&#46; The distribution of the principal characteristics by diabetes subtype is summarised in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; It should be noted that 4983 patients diagnosed with diabetes were not subcategorised to T1DM or T2DM&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The diagnosis most often associated with diabetes was congestive heart failure&#44; identified in 17&#46;9&#37; of patients with T2DM and 20&#46;1&#37; of patients with T1DM&#44; compared to 6&#46;4&#37; of all hospitalised patients in the period analysed&#46; This was followed by admission motivated by glycaemic control disorders&#58; 8&#46;4&#37; of patients with T2DM &#40;6&#46;1&#37; decompensated diabetes&#59; 2&#46;3&#37; hypoglycaemia&#41; and 18&#46;7&#37; of patients with T1DM &#40;11&#46;3&#37; decompensated diabetes&#59; 5&#46;9&#37; hypoglycaemia&#59; 1&#46;5&#37; diabetic ketoacidosis&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Diabetes and heart failure are two entities that often occur concomitantly&#44; accounting for 20&#46;1&#37; of hospitalisations in patients with T2DM according to ministerial data&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The results of our analysis underscore the importance of this association&#44; suggesting that it is also likely to extend to patients with T1DM&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">However&#44; important limitations intrinsically associated with errors in the preparation of the EHRs from which the information is obtained must be taken into account&#46; For example&#44; in our results&#44; we see that 4983 patients diagnosed with diabetes &#40;15&#46;45&#37; of the total number of people with diabetes&#41; are not subcategorised to type 1 or type 2 diabetes&#46; Moreover&#44; the prevalence of patients categorised as T1DM is excessive - it is 10 times higher in the data obtained in the hospitalised population than in the general population&#46; This is probably due to confusion in the encoding in many cases by the healthcare professionals who write the hospitalisation discharge reports for insulin-dependent patients with T2DM or T1DM&#44; since the Savana Manager&#174; tool classifies the diagnosis &#8220;insulin-dependent diabetes mellitus&#8221; as &#8220;type 1 diabetes&#8221;&#44; which makes it impossible for us to reach definitive conclusions with the data obtained in this subpopulation&#46; Finally&#44; it should be noted that this tool does not currently allow for statistical analysis of the data obtained&#44; so it cannot yet fully replace traditional research&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">As a final conclusion&#44; big data still requires some adjustments&#44; in which doctors must play a role&#46; Despite this&#44; big data analytics is becoming increasingly present in our lives and we are already obtaining the first results of its application&#46; This new technology will very soon provide differential value&#44; opening a new door to knowledge&#44; which will mean a revolution never seen before in the world of health&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authorship&#47;collaborators</span><p id="par0055" class="elsevierStylePara elsevierViewall">D&#46;E&#46; Barajas Galindo was responsible for the conception and design of the study&#46; D&#46;E&#46; Barajas Galindo&#44; B&#46; Pintor de la Maza&#44; I&#46; Cano Rodr&#237;guez and M&#46;D&#46; Ballesteros Pomar participated in the conduct of the study&#44; writing of the manuscript and reviewing the final version&#46;</p></span></span>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospitalisation episodes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3287&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;968&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32&#44;238&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">139&#44;688&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Number of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">945&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;077&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#44;470&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#44;750&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Episodes&#47;patient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;SD 19&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;SD 11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;SD 13&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;SD 19&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gender &#40;&#37; male&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Stay &#40;days&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#46;2 &#40;SD 10&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#46;3 &#40;SD 12&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#46;2 &#40;SD 17&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;1 &#40;SD 21&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#46;16&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical data of hospitalised patients based on history of diabetes&#46;</p>"
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Article information
ISSN: 25300180
Original language: English
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es en pt

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