A prognostic model based on readily available clinical data enriched a preemptive pharmacogenetic testing program
Published Date:Nov 25 2015
Source:J Clin Epidemiol. 72:107-115.
Computer Decision Support
Decision Support Systems, Clinical
Electronic Health Records
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Predictive Value Of Tests
Proportional Hazards Models
Reproducibility Of Results
Pubmed Central ID:PMC4779720
Funding:U01 HG007253/HG/NHGRI NIH HHS/United States
U01HL122904/HL/NHLBI NIH HHS/United States
UL1 TR000445/TR/NCATS NIH HHS/United States
U47CI000824/CI/NCPDCID CDC HHS/United States
UL1TR000445/TR/NCATS NIH HHS/United States
R01HL094786/HL/NHLBI NIH HHS/United States
U01 HL122904/HL/NHLBI NIH HHS/United States
U19 HL065962/HL/NHLBI NIH HHS/United States
R01 HL094786/HL/NHLBI NIH HHS/United States
U47 CI000824/CI/NCPDCID CDC HHS/United States
U19HL065962/HL/NHLBI NIH HHS/United States
U01 HG008672/HG/NHGRI NIH HHS/United States
RC2 GM092618/GM/NIGMS NIH HHS/United States
U01 HG006378/HG/NHGRI NIH HHS/United States
U01HG006378/HG/NHGRI NIH HHS/United States
RC2GM092318/GM/NIGMS NIH HHS/United States
We describe the development, implementation, and evaluation of a model to preemptively select patients for genotyping based on medication exposure risk.
Study Design and Setting
Using de-identified electronic health records (EHR), we derived a prognostic model for the prescription of statins, warfarin, or clopidogrel. The model was implemented into a clinical decision support (CDS) tool to recommend preemptive genotyping for patients exceeding a prescription risk threshold. We evaluated the rule on an independent validation cohort, and on an implementation cohort, representing the population in which the CDS tool was deployed.
The model exhibited moderate discrimination with area under the receiver operator characteristic curves ranging from 0.68 to 0.75 at one and two years following index dates. Risk estimates tended to underestimate true risk. The cumulative incidences of medication prescriptions at one and two years were 0.35 and 0.48, respectively, among 1673 patients flagged by the model. The cumulative incidences in the same number of randomly sampled subjects were 0.12 and 0.19, and in patients over 50 years with the highest body mass indices, they were 0.22 and 0.34.
We demonstrate that prognostic algorithms can guide preemptive pharmacogenetic testing towards those likely to benefit from it.
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