JMIR Publications

ABSTRACT

Background:

Multiple long-term conditions (MLTCs) present a public health challenge, requiring complex and prolonged treatment regimens. Remission or resolution (referred to here as remission) in long-term conditions (LTCs) is important for understanding disease progression and evaluating treatment effectiveness. Electronic Health Records (EHRs) are increasingly used to monitor clinical outcomes, but how remission is defined within EHRs remains unclear.

Objective:

To summarise and collate previous literature on how remission of LTCs has been defined in EHRs.

Methods:

Systematic electronic searches were performed across three databases (OVID Medline, Embase, and the Cochrane Library) for studies published from inception to November 2024. Additional grey literature searches were conducted to identify further references. The review included quantitative studies on adult populations, published in the English language, and utilising EHRs to assess remission (or resolution) of a LTC.

Results:

A total of 1,637 studies were identified, of which 54 met the inclusion criteria. These were conducted across the United States, United Kingdom, Australia, Japan, New Zealand, China, Kuwait, Brazil, Turkey, and Europe, with the majority being cohort studies. Studies assessed how remission or resolution was defined in 11 LTCs, including inflammatory bowel disease, diabetes, depression, epilepsy, anaemia, chronic kidney disease, autoimmune pancreatitis, substance dependence, heart disease, asthma, and hypertension. Remission was typically defined using a combination of diagnostic codes, validated rating scales, biochemical markers, absence of condition-specific events (such as hospital admissions), and cessation of pharmacological treatments. There was substantial variation in the criteria and duration of follow-up used to define remission. Some studies relied on clinical definitions (n=22), while others included laboratory data (n=19) or patient-reported outcomes (n=13).

Conclusions:

This review demonstrates that the remission of LTCs can be identified and operationalised within EHRs. Standardising definitions of remission presents a valuable opportunity to advance understanding of disease trajectories, particularly in the context of MLTC. These findings provide a foundation for developing strategies aimed at increasing the remission of MLTC, with the goal of reducing disease burden and improving patient lives. Further research is required to determine which conditions are most amenable to remission and to identify the factors associated with greater likelihood of remission, in order to inform the design of future interventions.