# Improving comparative effectiveness research through electronic health records continuity cohorts

> **NIH NIH R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2020 · $319,494

## Abstract

Title: Improving comparative effectiveness research through electronic health records
continuity cohorts
PI: Joshua Lin, MD, MPH
Abstract (about 30 lines)
Epidemiologic analyses of health care data can provide critical evidence on the effectiveness and safety of
therapeutics in the routine care setting since clinical trials often exclude frail and older patients who are the
primary consumers of most medications. Electronic health record (EHR) databases contain rich clinical
information vital for many comparative effectiveness studies and have been increasingly used for drug research.
There are currently more than 50 EHR-based research networks in the US. It is thus critical to understand how
we can conduct valid comparative clinical studies with EHR data. However, other than few highly integrated
plans, most US EHR systems do not have comprehensive capture of medical encounters across the care
continuum and may miss substantial amounts of information. Exposures, co-morbidities, and health outcomes
that are recorded at a clinic or hospital outside of a given EHR system are "invisible" to the investigator,
increasing misclassification or complete omission of essential variables. While such issues are pervasive, no
prior study has ever quantified the magnitude of resultant bias and how to remedy the situation if linkage of
more information is not feasible. To address this knowledge gap, we have combined longitudinal claims data
from Medicare with EHR patient data from a large multi-center health care system as a `gold standard' setup
where the claims data comprehensively capture medical information across care settings and provider systems
and EHR provides necessary clinical data. We will (1) use these `gold standard' data to identify `EHR continuity
cohorts' for whom the EHR system captures a high proportion of all encounters and evaluate whether
misclassification/omission of a list of essential variables in the comparative effectiveness research is
substantially reduced within vs outside of the EHR continuity cohort; (2) develop strategies to identify the EHR
continuity cohort based on a set of proxy indicators available in typical EHR databases and validate the
candidate prediction rules internally in a sample within the given EHR and externally using a second EHR
system that is also linked to Medicare claims data; (3) assess research validity and generalizability in the EHR
continuity cohorts in several empirical studies; and (4) Develop structured recommendation on how to conduct
comparative effectiveness research using high-validity EHR continuity cohorts in an EHR system without
linked claims data and make our program public available to facilitate future research using EHR-based
research networks.

## Key facts

- **NIH application ID:** 9983157
- **Project number:** 5R01LM012594-04
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** JOSHUA K LIN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $319,494
- **Award type:** 5
- **Project period:** 2017-09-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9983157

## Citation

> US National Institutes of Health, RePORTER application 9983157, Improving comparative effectiveness research through electronic health records continuity cohorts (5R01LM012594-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9983157. Licensed CC0.

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