{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T07:16:55Z","timestamp":1782544615039,"version":"3.54.5"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T00:00:00Z","timestamp":1661385600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["1R01AI151072"],"award-info":[{"award-number":["1R01AI151072"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Though targeted testing for latent tuberculosis infection (\u201cLTBI\u201d) for persons born in countries with high tuberculosis incidence (\u201cHTBIC\u201d) is recommended in health care settings, this information is not routinely recorded in the electronic health record (\u201cEHR\u201d). We develop and validate a prediction model for birth in a HTBIC using EHR data.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>In a cohort of patients within Kaiser Permanente Southern California (\u201cKPSC\u201d) and Kaiser Permanent Northern California (\u201cKPNC\u201d) between January 1, 2008 and December 31, 2019, KPSC was used as the development dataset and KPNC was used for external validation using logistic regression. Model performance was evaluated using area under the receiver operator curve (\u201cAUCROC\u201d) and area under the precision and recall curve (\u201cAUPRC\u201d). We explored various cut-points to improve screening for LTBI.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>KPSC had 73% and KPNC had 54% of patients missing country-of-birth information in the EHR, leaving 2,036,400 and 2,880,570 patients with EHR-documented country-of-birth at KPSC and KPNC, respectively. The final model had an AUCROC of 0.85 and 0.87 on internal and external validation datasets, respectively. It had an AUPRC of 0.69 and 0.64 (compared to a baseline HTBIC-birth prevalence of 0.24 at KPSC and 0.19 at KPNC) on internal and external validation datasets, respectively. The cut-points explored resulted in a number needed to screen from 7.1\u20138.5 persons\/positive LTBI diagnosis, compared to 4.2 and 16.8 persons\/positive LTBI diagnosis from EHR-documented birth in a HTBIC and current screening criteria, respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>Using logistic regression with EHR data, we developed a simple yet useful model to predict birth in a HTBIC which decreased the number needed to screen compared to current LTBI screening criteria.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Our model improves the ability to screen for LTBI in health care settings based on birth in a HTBIC.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0273363","type":"journal-article","created":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T17:46:40Z","timestamp":1661449600000},"page":"e0273363","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Development and validation of a prediction algorithm to identify birth in countries with high tuberculosis incidence in two large California health systems"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5343-0002","authenticated-orcid":true,"given":"Heidi","family":"Fischer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Qian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacek","family":"Skarbinski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8277-2431","authenticated-orcid":true,"given":"Katia J.","family":"Bruxvoort","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kris","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura B.","family":"Amsden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariah S.","family":"Wood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abigail","family":"Eaton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigitte C.","family":"Spence","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6553-1772","authenticated-orcid":true,"given":"Sally F.","family":"Shaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara Y.","family":"Tartof","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,8,25]]},"reference":[{"key":"pone.0273363.ref001","unstructured":"Tuberculosis (TB): Fact Sheet. Accessed October 12, 2021. https:\/\/www.cdc.gov\/tb\/publications\/factsheets\/general\/ltbiandactivetb.htm."},{"key":"pone.0273363.ref002","unstructured":"Tuberculosis. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/tuberculosis World Health Organization. Accessed November 16, 2021."},{"key":"pone.0273363.ref003","doi-asserted-by":"crossref","first-page":"409","DOI":"10.15585\/mmwr.mm7012a1","article-title":"Tuberculosis\u2014United States, 2020","volume":"70","author":"M Deutsch-Feldman","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"11","key":"pone.0273363.ref004","doi-asserted-by":"crossref","first-page":"289","DOI":"10.15585\/mmwr.mm6611a2","article-title":"Tuberculosis\u2014United States, 2016","volume":"66","author":"KM Schmit","year":"2017","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"pone.0273363.ref005","author":"H Johnson","year":"2019","journal-title":"Just the Facts: Immigrants in California"},{"key":"pone.0273363.ref006","unstructured":"TB in California: 2020 Snapshot; California Department of Public Health, 2021. Accessed August 25,2021. https:\/\/cchealth.org\/tb\/pdf\/TB-In-California.pdf."},{"issue":"Rr-6","key":"pone.0273363.ref007","first-page":"1","article-title":"Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society","volume":"49","year":"2000","journal-title":"MMWR Recommendations and reports: Morbidity and mortality weekly report Recommendations and reports"},{"issue":"3","key":"pone.0273363.ref008","first-page":"1","article-title":"A strategic plan for the elimination of tuberculosis in the United States","volume":"38","author":"WR Dowdle","year":"1989","journal-title":"MMWR supplements"},{"issue":"8","key":"pone.0273363.ref009","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1164\/rccm.200510-1563OC","article-title":"The scope and impact of treatment of latent tuberculosis infection in the United States and Canada","volume":"173","author":"TR Sterling","year":"2006","journal-title":"American journal of respiratory and critical care medicine"},{"issue":"66","key":"pone.0273363.ref010","doi-asserted-by":"crossref","first-page":"295","DOI":"10.15585\/mmwr.mm6611a3","article-title":"Tuberculosis Among Foreign-Born Persons Diagnosed \u226510 Years After Arrival in the United States, 2010\u20132015","author":"LA Tsang CA","year":"2017","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"4","key":"pone.0273363.ref011","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1001\/jama.300.4.405","article-title":"Tuberculosis Among Foreign-Born Persons in the United States","volume":"300","author":"KP Cain","year":"2008","journal-title":"JAMA"},{"key":"pone.0273363.ref012","volume-title":"California Adult Tuberculosis Risk Asessment and User Guide","author":"California Department of Public Health","year":"2017"},{"key":"pone.0273363.ref013","article-title":"Screening for latent tuberculosis infection in adults: US Preventive Services Task Force recommendation statement","author":"Force UPST","year":"2016","journal-title":"J JAMA"},{"key":"pone.0273363.ref014","article-title":"Is language at medical visit or at home a good proxy for country of birth?","author":"A Readhead","year":"2019","journal-title":"Poster presented at: National TB Conference"},{"issue":"3","key":"pone.0273363.ref015","doi-asserted-by":"crossref","first-page":"37","DOI":"10.7812\/TPP\/12-031","article-title":"Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data","volume":"16","author":"C Koebnick","year":"2012","journal-title":"The Permanente journal"},{"key":"pone.0273363.ref016","author":"NP Gordon","journal-title":"Similarity of the adult Kaiser Permanente membership in Northern California to the insured and general population in Northern California: statistics from the 2011 California Health Interview Survey"},{"key":"pone.0273363.ref017","volume-title":"Latent Tuberculosis Infection Guidance for Preventing Tuberculosis in California, CDPH CTCA Joint Guideline, 2018 Revision","year":"2018"},{"issue":"4","key":"pone.0273363.ref018","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.ipm.2009.03.002","article-title":"A systematic analysis of performance measures for classification tasks","volume":"45","author":"M Sokolova","year":"2009","journal-title":"J Information processing & management"},{"key":"pone.0273363.ref019","volume-title":"Joint European conference on machine learning and knowledge discovery in databases","author":"Springer","year":"2013"},{"issue":"5","key":"pone.0273363.ref020","first-page":"992","article-title":"Forecasting","volume":"23","author":"AA Bradley","year":"2008","journal-title":"Sampling uncertainty and confidence intervals for the Brier score and Brier skill score"},{"issue":"11","key":"pone.0273363.ref021","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1109\/LSP.2014.2337313","article-title":"Fast implementation of DeLong\u2019s algorithm for comparing the areas under correlated receiver operating characteristic curves","volume":"21","author":"X Sun","year":"2014","journal-title":"J IEEE Signal Processing Letters"},{"key":"pone.0273363.ref022","volume-title":"Regression modeling strategies: 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