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The Utility of Clinical Notes for Sexual Minority Health Research

  • Kristine E. Lynch
    Correspondence
    Address correspondence to: Kristine E. Lynch, PhD, VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City UT 84148.
    Affiliations
    VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah

    Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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  • Patrick R. Alba
    Affiliations
    VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah

    Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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  • Olga V. Patterson
    Affiliations
    VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah

    Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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  • Benjamin Viernes
    Affiliations
    VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah

    Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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  • Gregorio Coronado
    Affiliations
    VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah

    Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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  • Scott L. DuVall
    Affiliations
    VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah

    Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
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Published:September 30, 2020DOI:https://doi.org/10.1016/j.amepre.2020.05.026

      Introduction

      Despite improvements in electronic medical record capability to collect data on sexual orientation, not all healthcare systems have adopted this practice. This can limit the usability of systemwide electronic medical record data for sexual minority research. One viable resource might be the documentation of sexual orientation within clinical notes. The authors developed an approach to identify sexual orientation documentation and subsequently derived a cohort of sexual minority patients using clinical notes from the Veterans Health Administration electronic medical record.

      Methods

      A hybrid natural language processing approach was developed and used to identify and categorize instances of terms and phrases related to sexual orientation in Veterans Health Administration clinical notes from 2000 to 2019. System performance was assessed with positive predictive value and sensitivity. Data were analyzed in 2019.

      Results

      A total of 2,413,584 sexual minority terms/phrases were found within clinical notes, of which 439,039 (18%) were found to be related to patient sexual orientation with a positive predictive value of 85.9%. Documentation of sexual orientation was found for 115,312 patients. When compared with 2,262 patients with a record of administrative coding for homosexuality, the system found mentions of sexual orientation for 1,808 patients (79.9% sensitivity).

      Conclusions

      When systemwide structured data are unavailable or inconsistent, deriving a cohort of sexual minority patients in electronic medical records for research is possible and permits longitudinal analysis across multiple clinical domains. Although limitations and challenges to the approach were identified, this study makes an important step forward for the Veterans Health Administration sexual minority research, and the methodology can be applied in other healthcare organizations.
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