Measuring Adoption of Patient Priorities-Aligned Care Using Natural Language Processing of Electronic Health Records: Development and Validation of the Model.

Javad Razjouyan,Lilian Dindo,Jennifer W Silva,Aanand D Naik,Lea Kiefer,Jennifer Freytag,Jaime Halaszynski,Edward Odom

doi:10.2196/18756

Abstract

BackgroundPatient Priorities Care (PPC) is a model of care that aligns health care recommendations with priorities of older adults who have multiple chronic conditions. Following identification of patient priorities, this information is documented in the patient’s electronic health record (EHR).ObjectiveOur goal is to develop and validate a natural language processing (NLP) model that reliably documents when clinicians identify patient priorities (ie, values, outcome goals, and care preferences) within the EHR as a measure of PPC adoption.MethodsThis is a retrospective analysis of unstructured National Veteran Health Administration EHR free-text notes using an NLP model. The data were sourced from 778 patient notes of 658 patients from encounters with 144 social workers in the primary care setting. Each patient’s free-text clinical note was reviewed by 2 independent reviewers for the presence of PPC language such as priorities, values, and goals. We developed an NLP model that utilized statistical machine learning approaches. The performance of the NLP model in training and validation with 10-fold cross-validation is reported via accuracy, recall, and precision in comparison to the chart review.ResultsOf 778 notes, 589 (75.7%) were identified as containing PPC language (kappa=0.82, P<.001). The NLP model in the training stage had an accuracy of 0.98 (95% CI 0.98-0.99), a recall of 0.98 (95% CI 0.98-0.99), and precision of 0.98 (95% CI 0.97-1.00). The NLP model in the validation stage had an accuracy of 0.92 (95% CI 0.90-0.94), recall of 0.84 (95% CI 0.79-0.89), and precision of 0.84 (95% CI 0.77-0.91). In contrast, an approach using simple search terms for PPC only had a precision of 0.757.ConclusionsAn automated NLP model can reliably measure with high precision, recall, and accuracy when clinicians document patient priorities as a key step in the adoption of PPC.

Highlights

Older adults with multiple chronic conditions (MCC) frequently receive some of the most intensive and expensive health care, much of which is of uncertain benefit [1,2,3]
Patient Priorities Care (PPC) is an intervention that aims to help clinicians provide health care to older patients with MCC that aligns with their priorities, which include their individual values, desired outcome goals, and health care preferences [1,2,3,4,5,6]
To create the natural language processing (NLP) model to assess the adoption of PPC, we used the notes of a cohort of social workers who were trained to be PPC clinicians over the course of 9 months

Summary

Introduction

Older adults with multiple chronic conditions (MCC) frequently receive some of the most intensive and expensive health care, much of which is of uncertain benefit [1,2,3] Care for these patients is often inconsistent and fragmented because the multiple specialists they see provide care based on single disease guidelines that do not take into account the complexities of MCC. The second key step in PPC involves documenting patient priorities in the patient’s electronic health record (EHR) [4,5] This makes information about patient priorities available to different clinicians working with adults with MCC. Following identification of patient priorities, this information is documented in the patient’s electronic health record (EHR)

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Discussion

Conclusion