Health Services Research Utilizing Electronic Health Record Data: A Grad Student 'How-To' Paper

Graduate students encounter many challenges when conducting health services research utilizing “real world” data obtained from electronic health records (EHRs). These challenges include cleaning and sorting data, summarizing and identifying present on admission diagnosis codes, identifying appropriate metrics for risk-adjustment, and determining the effectiveness and cost effectiveness of treatments. This paper provides graduate students with basic tools for the conduct of health services research with EHR data. We will examine SAS tools and step-by-step approaches used in an analysis of the effectiveness and cost-effectiveness of the ABCDE (Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility) bundle in improving outcomes for intensive care unit (ICU) patients. These tools include: 1) ARRAYS, 2) Table Look-up, 3) LAG functions, 4) PROC TABULATE, 5) recycled predictions, and 6) bootstrapping. We will discuss challenges and lessons learned in working with data obtained from the EHR. This content is appropriate for beginning SAS users.