Enhancing gout management by creating a register using automated queries in electronic health records

ObjectiveTo develop an automatic gout register to improve gout management. MethodsWe analysed the electronic health records (EHR) of all patients >18 years old from a tertiary academic hospital (2013-2022) based on six criteria: International Classification of Diseases 10 (ICD-10) gout diagnosis, urate-lowering therapy (ULT) prescription, uric acid crystal in joint aspiration and gout-related terms in problem lists, clinical or imaging reports. We assessed the positive and negative predictive value (PPV and NPV) of the query by chart reviews. ResultsOf 2,110,902 out- and inpatients, 10,289 had at least one criterion for gout. The combination of joint aspiration OR diagnostic in the problem list OR [≥] 2 other criteria created a register of 5,138 patients, with a PPV of 92.4% (95%CI: 88.5 to 95.0), and an NPV of 94.3% (95%CI: 91.9 to 96.0). PPV and NPV were similar amongst outpatients and inpatients. Incidence was 2.9 per 1000 person-year and dropped by 30% from the COVID-19 pandemic onward. Patients with gout were on average 71.2 years old (SD 14.9), mainly male (76.5%), overweight (69.5%) and polymorbid (mean number of comorbidities of 3, IQR 1-5). More than half (57.4%) had received a urate lowering treatment, 6.7% had a gout that led to a hospitalisation or [≥]2 flares within a year, and 32.9% received a rheumatology consultation. ConclusionAn automatic EHR-based gout register is feasible, valid and could be used to evaluate and improve gout management. Interestingly, the register uncovered a marked underdiagnosis or underreporting of gout since the COVID-19 pandemic. Key messagesWhat is already known on this topic? - Gout is the most prevalent inflammatory arthritis, but it remains undertreated despite affordable and effective treatment options. - Quantifying this undertreatment and detecting its causes and risk factors to pilot quality improvement initiative requires an extensive register of gout patients. What this study adds? - This is the first automatic EHR-based gout register, allowing frequent, inexpensive, and sustainable updates. - The automated queries show high positive and negative predictive values to identify gout patients. How this study might affect research, practice or policy? - This register can facilitate the assessment of the adequacy of gout management and the monitoring of quality indicators following improvement projects, or change in policies - It provides an easy platform for cohort studies or adaptive trials - Its methodology is reproducible, facilitating the establishment of gout or other disease registers within different EHR systems