Speech and Language Disorders in Older Canadians: Epidemiologic Primary Care-Based Research Using the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) Database Open Access
- Other title
case definition validation
speech and language disorders
- Type of item
- Degree grantor
University of Alberta
- Author or creator
Miyagishima, Rebecca C.
- Supervisor and department
Drummond, Neil (School of Public Health, Family Medicine)
Carroll, Linda (School of Public Health)
Hopper, Tammy (Communication Sciences and Disorders)
- Examining committee member and department
Eurich, Dean (School of Public Health)
School of Public Health
- Date accepted
- Graduation date
Master of Science
- Degree level
Objectives: The objective of this study is to examine the epidemiology and clinical management in primary care of speech and language disorders in older adults (fifty-five and older) and to assess the utility and feasibility of EMR data to answer such research questions. This study is comprised of a case definition validation study through which prevalence was estimated. Methods: This study was a combined case definition validation and cross-sectional prevalence study. The study involved development of a case definition through which a chart review was undertaken to serve as the ‘gold standard’. Following the chart review, the case definition was converted into a computer algorithm and applied to the same list of patients as the chart review. The results were assessed for sensitivity, specificity, positive predictive value and negative predictive value. Prevalence was assessed using the chart review. Results: Prevalence within our sample of 1384 patients was 1.2%. The case definition had favourable specificity (99.9%, 95% CI: 99.6% - 100.0%) as well as positive predictive value (75.6%, 95% CI: 25.4% - 96.6%) and negative predictive value (99.0%, 95% CI: 98.8% - 99.2%). Sensitivity was not sufficient for validity (18.8%, 95% CI: 4.05% - 45.6%). Conclusions: The case definition formulated did not meet an acceptable standard for validity, and thus could not be used to determine national prevalence of speech and language disorders within the CPCSSN database. However, due to the case definition’s high positive and negative predictive values, it may be useful for clinical purposes, rather than epidemiologic applications. Due to the compounded issues of ‘subjective’ diagnosis for speech and language disorders and limitations of EMR-derived data for subjectively diagnosed diseases, speech and language disorders are a set of conditions which may not be easily studied in this context. Finally, while the case definition did not prove valid, this study has provided a robust estimate of prevalence (1.2%) which is not based on composite data, nor is limited by etiology.
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