Objective An internal pre-transplant risk assessment tool or Risk Monitor was developed by the Baylor Blood & Marrow Transplant (BMT) Data Management and Analytics team to assist with optimization of patient selection. The tool assigns a total risk score for allogeneic transplants based on attributes such as disease status, disease risk index (DRI), patient age, Karnofsky performance status (KPS), hematopoietic cellular therapy co-morbidity index (HCT-CI), and CMV status, along with psychosocial factors such as caregiver support, coping skills or motivation, health literacy, medication compliance, socioeconomic viability, distance of residence from the transplant center, as well as others. A retrospective pilot study was conducted to predict which attributes have the highest correlation with the primary outcome variable, post-transplant patient mortality. Method The Risk Monitor was developed using Microsoft Access (Microsoft®, Redmond, WA). A score of 0 (no risk) or 1 (risk) was assigned for each variable and an aggregate score was calculated for each patient (Figure 1). The data was analyzed using Waikato Environment for Knowledge Analysis (Weka). Weka is an open-source data mining tool consisting of a collection of machine learning algorithms for data mining tasks. It contains tools for data preparation, classification, regression, clustering, association rules mining, and visualization. Results We evaluated the total risk score for 97 patients that had undergone an allogeneic stem cell transplant (SCT) at Baylor University Medical Center in 2016. The total risk score for the patients varied between 0 and 9. Weka provided us with a list of independent attributes with rankings based on the intensity of correlation with the dependent variable, early mortality. Evaluation of the data set suggests that one attribute (Total Score) has the highest correlation with mortality, while other individual attributes (KPS, CMV status, DRI, HCT-CI and psychosocial factors such as caregiver support, coping skills, and health literacy) demonstrated a moderate to high correlation (Figure 2). Conclusion The Risk Monitor can serve as a useful tool for screening adult patients prior to allogeneic transplant. In addition, the tool may help to identify patients who need additional screening and social support to minimize the possibility of early mortality after transplantation. The Access database has been transitioned to a web-based (SQL Server/PHP/JavaScript) application to overcome certain Access-related issues such as client software installation, file corruption and interface update issues. Furthermore, this will enable easy cross platform usage, enhance security, and allow more concurrent users.
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