Would you like to add a weight after this blood pressure, doctor? Discovery of potentially actionable associations between the provision of multiple screens in primary care

Rationale, aims, and objective:  Guidelines recommend screening for risk factors associated with chronic diseases but current electronic prompts have limited effects. Our objective was to discover and rank associations between the presence of screens to plan more efficient prompts in primary care.

Methods:  Risk factors with the greatest impact on chronic diseases are associated with blood pressure, body mass index, waist circumference, glycaemic and lipid levels, smoking, alcohol use, diet, and exercise. We looked for associations between the presence of screens for these in electronic medical records. We used association rule mining to describe relationships among items, factor analysis to find latent categories, and Cronbach α to quantify consistency within latent categories.

Results:  Data from 92 140 patients in or around Toronto, Ontario, were included. We found positive correlations (lift >1) between the presence of all screens. The presence of any screen was associated with confidence greater than 80% that other data on items with high prevalence (blood pressure, glycaemic and lipid levels, or smoking) would also be present. A cluster of rules predicting the presence of blood pressure were ranked highest using measures of interestingness such as standardized lift. We found 3 latent categories using factor analysis; these were laboratory tests, vital signs, and lifestyle factors; Cronbach α ranged between .58 for lifestyle factors and .88 for laboratory tests.

Conclusions:  Associations between the provision of important screens can be discovered and ranked. Rules with promising combinations of associated screens could be used to implement data driven alerts.