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Year:: 2024
Contributor:: Kennard, Maeghan (Author); Sarkar, Indra Neil (Author); Bradenday, Jonah (Author); Saal, Andrew (Author)
Subject:: public health; addiction; drug use; coding; electronic health records; marijuana
DOI: https://doi.org/10.26300/pfd0-7766

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Abstract:: Introduction Over the past twelve years, several states legalized recreational marijuana use, including Rhode Island in 2022. Electronic Health Records (EHRs) have not adapted to document the evolving use, making evaluation of long-term impacts on public health difficult. We used de-identified data provided by the Rhode Island Department of Health (RIDOH) and the Rhode Island Quality Institute (RIQI), which operates CurrentCare, Rhode Island’s statewide Health Information Exchange (HIE), to examine relationships between marijuana use and several chronic health conditions, and the rates and visit types at which marijuana use was recorded. Methods Design: Quantitative analysis of patients with a documented history of marijuana use concurrent with diagnoses of essential hypertension or COPD/asthma, excluding diagnoses of tobacco usage. Visit types at which marijuana usage was initially documented in the EHR were also examined. Rates were compared to population estimates from the National Health and Nutrition Examination Survey (NHANES). Setting: Rhode Island clinics/hospitals that participated in CurrentCare. Participants: From 536,000+ patients within CurrentCare, a de-identified subset of patients with at least one systolic blood pressure reading were included. Instrument: Unified Research data Sharing and Access (URSA) Stronghold to analyze the data. Analysis: Patients were identified using ICD-10 diagnostic codes associated with marijuana use, cannabis use, or cannabis abuse. Results Of 129,887 patients examined, 4,308 (3.32%) had documented marijuana use. These patients were 50.97% male and 49.00% female. Within patients with documented marijuana use, excluding diagnoses of tobacco use, 599 (13.90%) had hypertension and 499 (11.58%) had COPD/asthma diagnoses. Initial documentation in EHRs occurred during an emergency visit for 1,321 (30.66%) of the patients with documented marijuana use. Conclusions Comparing rates of marijuana use documentation in electronic health records to NHANES self-reported rates of usage indicated there is under-reporting of marijuana usage in Rhode Island. Almost one-third of documentation occurred in an emergency setting, indicating there may be potential biases in documenting the varying degrees of marijuana use by patients. These factors make it difficult to establish accurate correlations between hypertension or COPD/asthma and marijuana use. Developing improved diagnostic codes for marijuana that describe usage patterns (i.e. sporadic, daily, problematic) may allow stronger correlations to be determined and reduce any potential bias in the reporting of marijuana use.

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Kennard, Maeghan, Sarkar, Indra Neil, Bradenday, Jonah, et al., "Marijuana Use in Rhode Island: Pitfalls in Clinical Coding and Documentation" (2024). Gateways to Medicine, Health Care, and Research. Brown Digital Repository. Brown University Library. https://doi.org/10.26300/pfd0-7766

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Gateways to Medicine, Health Care, and Research

The Gateways Program at the Warren Alpert Medical School of Brown University provides academically promising, motivated students new pathways to careers in the health sciences. This collection houses scholarly works produced by Master of Science in Medical Sciences (ScM) students …
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Marijuana Use in Rhode Island: Pitfalls in Clinical Coding and Documentation