Clinical Scorecard: Assessing Bias in Electronic Health Record Data: An Agent-Based Model Approach to Investigate Geographic Disparities in Community-Acquired Methicillin-Resistant Staphylococcus aureus Linked to Variations in Health Care-Seeking Behavior

At a Glance

Key Highlights

• EHR data may reflect bias due to differential health care–seeking behavior, potentially inflating geographic disparities in CA-MRSA prevalence.
• Agent-based modeling (ABM) simulating homogeneous disease prevalence and varying health care–seeking behaviors partially reproduced observed geographic disparities.
• Geographic disparities in CA-MRSA prevalence likely arise from factors beyond health care access and seeking behaviors alone.

Guideline-Based Recommendations

Diagnosis

• Consider potential bias in EHR-based CA-MRSA prevalence estimates due to differential health care–seeking behavior.

Management

• Use comprehensive data sources beyond EHRs to assess true disease burden and geographic disparities.

Monitoring & Follow-up

• Incorporate modeling approaches like ABM to understand the impact of health care–seeking behavior on observed data.

Risks

• Risk of overestimating disease burden in low-income or rural areas due to differential access and utilization of health care services.

Patient & Prescribing Data

Individuals with community-acquired MRSA infections presenting to emergency departments in California

Approximately 50% of individuals with CA-MRSA may not seek medical care, leading to underrepresentation in EHR data.

Clinical Best Practices

• Interpret EHR-derived infection prevalence with caution, accounting for potential biases from health care–seeking behavior.
• Employ agent-based modeling to simulate and adjust for health care access and utilization patterns in epidemiologic studies.
• Recognize that geographic disparities in CA-MRSA may reflect complex social and environmental determinants beyond health care access.

References

• California Office of Health Care Access and Information (HCAI) ED Data
• Epidemiologic analysis of CA-MRSA geographic disparities in California
• National survey on health care–seeking behavior for skin and soft tissue infections