Third external replication of an individualised transdiagnostic prediction model for the automatic detection of individuals at risk of psychosis using electronic health records

TY - JOUR

T1 - Third external replication of an individualised transdiagnostic prediction model for the automatic detection of individuals at risk of psychosis using electronic health records

AU - Puntis, Stephen

AU - Oliver, Dominic

AU - Fusar-Poli, Paolo

N1 - Funding Information: S.P. is funded by a National Institute for Health Research Post Doctoral Fellowship award (grant number PDF-2017-10-029 ). This study was supported by the UK Clinical Record Interactive Search (UK-CRIS) system using data and systems of the NIHR Oxford Health Biomedical Research Centre ( BRC-1215-20005 ). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. This study was also supported by the King's College London Confidence in Concept award from the Medical Research Council (MRC) ( MC_PC_16048 ) to PF-P. DO is supported by the UK Medical Research Council ( MR/N013700/1 ) and King's College London member of the MRC Doctoral Training Partnership in Biomedical Sciences. Publisher Copyright: © 2021 Elsevier B.V. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/2

Y1 - 2021/2

N2 - Background: Primary indicated prevention is a key target for reducing the incidence and burden of schizophrenia and related psychotic disorders. An individualised, clinically-based transdiagnostic model for the detection of individuals at risk of psychosis has been developed and validated in two large, urban healthcare providers. We tested its external validity in a geographically and demographically different non-urban population. Method: Retrospective EHR cohort study. All individuals accessing secondary healthcare provided by Oxford Health NHS Foundation Trust between 1st January 2011 and 30th November 2019 and receiving a primary index diagnosis of a non-psychotic or non-organic mental disorder were considered eligible. The previously developed model was applied to this database and its external prognostic accuracy was measured with Harrell's C. Findings: The study included n = 33,710 eligible individuals, with an average age of 27.7 years (SD = 19.8), mostly white (92.0%) and female (57.3%). The mean follow-up was 1863.9 days (SD = 948.9), with 868 transitions to psychosis and a cumulative incidence of psychosis at 6 years of 2.9% (95%CI: 2.7–3.1). Compared to the urban development database, Oxford Health was characterised by a relevant case mix, lower incidence of psychosis, different distribution of baseline predictors, higher proportion of white females, and a lack of specialised clinical services for at risk individuals. Despite these differences the model retained an adequate prognostic performance (Harrell's C = 0.79, 95%CI: 0.78–0.81), with no major miscalibration. Interpretation: The transdiagnostic, individualised, clinically-based risk calculator is transportable outside urban healthcare providers. Further research should test transportability of this risk prediction model in an international setting.

AB - Background: Primary indicated prevention is a key target for reducing the incidence and burden of schizophrenia and related psychotic disorders. An individualised, clinically-based transdiagnostic model for the detection of individuals at risk of psychosis has been developed and validated in two large, urban healthcare providers. We tested its external validity in a geographically and demographically different non-urban population. Method: Retrospective EHR cohort study. All individuals accessing secondary healthcare provided by Oxford Health NHS Foundation Trust between 1st January 2011 and 30th November 2019 and receiving a primary index diagnosis of a non-psychotic or non-organic mental disorder were considered eligible. The previously developed model was applied to this database and its external prognostic accuracy was measured with Harrell's C. Findings: The study included n = 33,710 eligible individuals, with an average age of 27.7 years (SD = 19.8), mostly white (92.0%) and female (57.3%). The mean follow-up was 1863.9 days (SD = 948.9), with 868 transitions to psychosis and a cumulative incidence of psychosis at 6 years of 2.9% (95%CI: 2.7–3.1). Compared to the urban development database, Oxford Health was characterised by a relevant case mix, lower incidence of psychosis, different distribution of baseline predictors, higher proportion of white females, and a lack of specialised clinical services for at risk individuals. Despite these differences the model retained an adequate prognostic performance (Harrell's C = 0.79, 95%CI: 0.78–0.81), with no major miscalibration. Interpretation: The transdiagnostic, individualised, clinically-based risk calculator is transportable outside urban healthcare providers. Further research should test transportability of this risk prediction model in an international setting.

KW - Detection

KW - Electronic health records

KW - Prevention

KW - Psychosis

KW - Schizophrenia

UR - http://www.scopus.com/inward/record.url?scp=85100415314&partnerID=8YFLogxK

U2 - 10.1016/j.schres.2021.01.005

DO - 10.1016/j.schres.2021.01.005

M3 - Article

AN - SCOPUS:85100415314

SN - 0920-9964

VL - 228

SP - 403

EP - 409

JO - Schizophrenia Research

JF - Schizophrenia Research

ER -