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Table 1 Iterative performance of antimicrobial prophylaxis identification algorithm in development stage with gold standard CART-EP Program Data (manual review; n = 2102 procedures in 38 facilities)a

From: Novel methodology to measure pre-procedure antimicrobial prophylaxis: integrating text searches with structured data from the Veterans Health Administration’s electronic medical record

Data Elements in Algorithm

CART-EP-reviewed cardiac device procedures (n = 2102)

PPV

(True flagged ‘yes abx’/All flagged ‘yes abx’)

NPV

(True flagged ‘no abx’/All flagged ‘no abx’)

Sensitivity (All flagged ‘yes abx’/Total ‘yes abx’ n = 2056)

Specificity (All flagged ‘no abx’/Total ‘no abx’, n = 46)

Manual review

2056 (97.8%)

Text note searches

1954 (93.0%)

1930/1954 (98.8%)

22/148 (14.9%)

1930 (93.9%)

22 (47.8%)

Orders

1899 (90.3%)

1883/1889 (99.2%)

30/203 (14.8%)

1883 (91.6%)

30 (65.3%)

Administration

150 (7.14%)

150/150 (100%)

46/1952 (2.36%)

150 (7.30%)

46 (100%)

Text note searches + Orders

2048 (97.4%)

2019/2048 (98.6%)

17/54 (31.5%)

2019 (98.2%)

17 (37.0%)

Text note searches + Administration

1955 (93.0%)

1931/1955 (98.8%)

22/147 (15.0%)

1931 (93.9%)

22 (47.8%)

Orders + Administration

1901 (90.4%)

1885/1901 (91.7%)

30/201 (14.9%)

1885 (91.7%)

30 (65.2%)

Text note searches + Orders + Administration

2048 (97.4%)

2019/2048 (98.6%)

17/54 (31.5%)

2019 (98.2%)

17 (37.0%)

Round 2 Changes

 Text note searches - Exclude oral medications

1950 (92.8%)

1928/1950 (98.9%)

24/152 (15.8%)

1928 (93.8%)

24 (52.2%)

 Limit list to common prophylaxis medications

2044 (97.2%)

2017/2044 (98.7%)

19/58 (32.8%)

2017 (98.1%)

19 (41.3%)

 Exclude notes from the day of the procedure

823 (39.1%)

823/825 (99.8%)

44/1277 (2.09%)

823 (40.0%)

44 (95.7%)

 Include term “prophylaxis” in text searches

2048 (97.4%)

2019/2048 (98.6%)

17/54 (31.5%)

2019 (98.2%)

17 (37.0%)

  1. aCART-EP Program data included 2102 cardiac device procedures with manually collected data on antimicrobial prophylaxis; of these, 2056 cases (97.8%) received antimicrobials prior to incision. Shaded cells indicate the elements of the final algorithm; details of these data elements and what tables they were applied to in the VA EMR are available in Appendix