Abstract
BackgroundAccess to palliative care is a key quality metric which most healthcare organizations strive to improve. The primary challenges to increasing palliative care access are a combination of physicians over-estimating patient prognoses, and a shortage of palliative staff in general. This, in combination with treatment inertia can result in a mismatch between patient wishes, and their actual care towards the end of life.MethodsIn this work, we address this problem, with Institutional Review Board approval, using machine learning and Electronic Health Record (EHR) data of patients. We train a Deep Neural Network model on the EHR data of patients from previous years, to predict mortality of patients within the next 3-12 month period. This prediction is used as a proxy decision for identifying patients who could benefit from palliative care.ResultsThe EHR data of all admitted patients are evaluated every night by this algorithm, and the palliative care team is automatically notified of the list of patients with a positive prediction. In addition, we present a novel technique for decision interpretation, using which we provide explanations for the model’s predictions.ConclusionThe automatic screening and notification saves the palliative care team the burden of time consuming chart reviews of all patients, and allows them to take a proactive approach in reaching out to such patients rather then relying on referrals from the treating physicians.
Highlights
Access to palliative care is a key quality metric which most healthcare organizations strive to improve
Of all the deaths that happen in the United States, up to 60% of them happen in an acute care hospital while the patient was receiving aggressive care
Results we report technical evaluation results obtained on the test set using the model selected based on the best Average Precision (AP) score on the validation set
Summary
Access to palliative care is a key quality metric which most healthcare organizations strive to improve. Data from the National Palliative Care registry estimates that, despite increasing access, less than half of the 7-8% of all hospital admissions that need palliative care receive it [3]. Physicians tend to be overoptimistic, work under extreme time pressures, and as a result may not fail to refer patients to palliative care even when they may benefit [5]. This leads to patients often failing to have their wishes carried out at their end of life [6] and overuse of aggressive care. The shortage of professionals in palliative care makes it expensive and time-consuming for them to proactive identify candidate patients via manual chart review of all admissions
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