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Osman M, Cooper R, Sayer AA, Witham MD. The use of natural language processing for the identification of ageing syndromes including sarcopenia, frailty and falls in electronic healthcare records: a systematic review. Age Ageing 2024; 53:afae135. [PMID: 38970549 PMCID: PMC11227113 DOI: 10.1093/ageing/afae135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Recording and coding of ageing syndromes in hospital records is known to be suboptimal. Natural Language Processing algorithms may be useful to identify diagnoses in electronic healthcare records to improve the recording and coding of these ageing syndromes, but the feasibility and diagnostic accuracy of such algorithms are unclear. METHODS We conducted a systematic review according to a predefined protocol and in line with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Searches were run from the inception of each database to the end of September 2023 in PubMed, Medline, Embase, CINAHL, ACM digital library, IEEE Xplore and Scopus. Eligible studies were identified via independent review of search results by two coauthors and data extracted from each study to identify the computational method, source of text, testing strategy and performance metrics. Data were synthesised narratively by ageing syndrome and computational method in line with the Studies Without Meta-analysis guidelines. RESULTS From 1030 titles screened, 22 studies were eligible for inclusion. One study focussed on identifying sarcopenia, one frailty, twelve falls, five delirium, five dementia and four incontinence. Sensitivity (57.1%-100%) of algorithms compared with a reference standard was reported in 20 studies, and specificity (84.0%-100%) was reported in only 12 studies. Study design quality was variable with results relevant to diagnostic accuracy not always reported, and few studies undertaking external validation of algorithms. CONCLUSIONS Current evidence suggests that Natural Language Processing algorithms can identify ageing syndromes in electronic health records. However, algorithms require testing in rigorously designed diagnostic accuracy studies with appropriate metrics reported.
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Affiliation(s)
- Mo Osman
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Rachel Cooper
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - Miles D Witham
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
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Pillai M, Blumke TL, Studnia J, Wang Y, Veigulis ZP, Ware AD, Hoover PJ, Carroll IR, Humphreys K, Osborne TF, Asch SM, Hernandez-Boussard T, Curtin CM. Improving postsurgical fall detection for older Americans using LLM-driven analysis of clinical narratives. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.25.24309480. [PMID: 38978655 PMCID: PMC11230313 DOI: 10.1101/2024.06.25.24309480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Postsurgical falls have significant patient and societal implications but remain challenging to identify and track. Detecting postsurgical falls is crucial to improve patient care for older adults and reduce healthcare costs. Large language models (LLMs) offer a promising solution for reliable and automated fall detection using unstructured data in clinical notes. We tested several LLM prompting approaches to postsurgical fall detection in two different healthcare systems with three open-source LLMs. The Mixtral-8×7B zero-shot had the best performance at Stanford Health Care (PPV = 0.81, recall = 0.67) and the Veterans Health Administration (PPV = 0.93, recall = 0.94). These results demonstrate that LLMs can detect falls with little to no guidance and lay groundwork for applications of LLMs in fall prediction and prevention across many different settings.
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Affiliation(s)
- Malvika Pillai
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Department of Medicine (Biomedical Informatics), Stanford University, Stanford, CA, USA
| | - Terri L Blumke
- National Center for Collaborative Healthcare Innovation, Palo Alto VA Healthcare System, Palo Alto, CA, USA
| | - Joachim Studnia
- Institute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA
| | - Yuqing Wang
- Department of Medicine (Biomedical Informatics), Stanford University, Stanford, CA, USA
| | | | - Anna D Ware
- National Center for Collaborative Healthcare Innovation, Palo Alto VA Healthcare System, Palo Alto, CA, USA
| | - Peter J Hoover
- National Center for Collaborative Healthcare Innovation, Palo Alto VA Healthcare System, Palo Alto, CA, USA
| | - Ian R Carroll
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Keith Humphreys
- Department of Psychiatry and the Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Thomas F Osborne
- National Center for Collaborative Healthcare Innovation, Palo Alto VA Healthcare System, Palo Alto, CA, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven M. Asch
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Catherine M Curtin
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
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3
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Shankar KN, Li A. Older Adult Falls in Emergency Medicine, 2023 Update. Clin Geriatr Med 2023; 39:503-518. [PMID: 37798062 DOI: 10.1016/j.cger.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Of 4 older adults, 1 will fall each year in the United States. Based on 2020 data from the Centers of Disease Control, about 36 million older adults fall each year, resulting in 32,000 deaths. Emergency departments see about 3 million older adults for fall-related injuries with falls having the ability to cause serious injury such as catastrophic head injuries and hip fractures. One-third of older fall patients discharged from the ED experience one of these outcomes at 3 months.
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Affiliation(s)
- Kalpana N Shankar
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Neville House, Boston, MA 02115, USA.
| | - Angel Li
- Department of Emergency Medicine, The Ohio State University, 376 West 10th Avenue, Columbus, OH 43210, USA
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4
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Hekman DJ, Cochran AL, Maru AP, Barton HJ, Shah MN, Wiegmann D, Smith MA, Liao F, Patterson BW. Effectiveness of an Emergency Department-Based Machine Learning Clinical Decision Support Tool to Prevent Outpatient Falls Among Older Adults: Protocol for a Quasi-Experimental Study. JMIR Res Protoc 2023; 12:e48128. [PMID: 37535416 PMCID: PMC10436111 DOI: 10.2196/48128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Emergency department (ED) providers are important collaborators in preventing falls for older adults because they are often the first health care providers to see a patient after a fall and because at-home falls are often preceded by previous ED visits. Previous work has shown that ED referrals to falls interventions can reduce the risk of an at-home fall by 38%. Screening patients at risk for a fall can be time-consuming and difficult to implement in the ED setting. Machine learning (ML) and clinical decision support (CDS) offer the potential of automating the screening process. However, it remains unclear whether automation of screening and referrals can reduce the risk of future falls among older patients. OBJECTIVE The goal of this paper is to describe a research protocol for evaluating the effectiveness of an automated screening and referral intervention. These findings will inform ongoing discussions about the use of ML and artificial intelligence to augment medical decision-making. METHODS To assess the effectiveness of our program for patients receiving the falls risk intervention, our primary analysis will be to obtain referral completion rates at 3 different EDs. We will use a quasi-experimental design known as a sharp regression discontinuity with regard to intent-to-treat, since the intervention is administered to patients whose risk score falls above a threshold. A conditional logistic regression model will be built to describe 6-month fall risk at each site as a function of the intervention, patient demographics, and risk score. The odds ratio of a return visit for a fall and the 95% CI will be estimated by comparing those identified as high risk by the ML-based CDS (ML-CDS) and those who were not but had a similar risk profile. RESULTS The ML-CDS tool under study has been implemented at 2 of the 3 EDs in our study. As of April 2023, a total of 1326 patient encounters have been flagged for providers, and 339 unique patients have been referred to the mobility and falls clinic. To date, 15% (45/339) of patients have scheduled an appointment with the clinic. CONCLUSIONS This study seeks to quantify the impact of an ML-CDS intervention on patient behavior and outcomes. Our end-to-end data set allows for a more meaningful analysis of patient outcomes than other studies focused on interim outcomes, and our multisite implementation plan will demonstrate applicability to a broad population and the possibility to adapt the intervention to other EDs and achieve similar results. Our statistical methodology, regression discontinuity design, allows for causal inference from observational data and a staggered implementation strategy allows for the identification of secular trends that could affect causal associations and allow mitigation as necessary. TRIAL REGISTRATION ClinicalTrials.gov NCT05810064; https://www.clinicaltrials.gov/study/NCT05810064. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48128.
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Affiliation(s)
- Daniel J Hekman
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Amy L Cochran
- Department of Population Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Apoorva P Maru
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Hanna J Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Manish N Shah
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States
| | - Douglas Wiegmann
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, United States
| | - Maureen A Smith
- Health Innovation Program, University of Wisconsin-Madison, Madison, WI, United States
| | - Frank Liao
- Department of Applied Data Science, UWHealth Hospitals and Clinics, University of Wisconsin-Madison, Madison, WI, United States
| | - Brian W Patterson
- BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, United States
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Engstrom CJ, Adelaine S, Liao F, Jacobsohn GC, Patterson BW. Operationalizing a real-time scoring model to predict fall risk among older adults in the emergency department. Front Digit Health 2022; 4:958663. [PMID: 36405416 PMCID: PMC9671211 DOI: 10.3389/fdgth.2022.958663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022] Open
Abstract
Predictive models are increasingly being developed and implemented to improve patient care across a variety of clinical scenarios. While a body of literature exists on the development of models using existing data, less focus has been placed on practical operationalization of these models for deployment in real-time production environments. This case-study describes challenges and barriers identified and overcome in such an operationalization for a model aimed at predicting risk of outpatient falls after Emergency Department (ED) visits among older adults. Based on our experience, we provide general principles for translating an EHR-based predictive model from research and reporting environments into real-time operation.
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Affiliation(s)
- Collin J. Engstrom
- Department of Emergency Medicine, UW-Madison, Madison, WI, United States
- Department of Computer Science, Winona State University, Rochester, MN, United States
- Correspondence: Collin J. Engstrom
| | - Sabrina Adelaine
- Department of Enterprise Analytics, UW Health, Madison, WI, United States
| | - Frank Liao
- Department of Enterprise Analytics, UW Health, Madison, WI, United States
| | | | - Brian W. Patterson
- Department of Emergency Medicine, UW-Madison, Madison, WI, United States
- Department of Biostatistics and Medical Informatics, UW-Madison, Madison, WI, United States
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Hunold KM, Goldberg EM, Caterino JM, Hwang U, Platts-Mills TF, Shah MN, Rosen T. Inclusion of older adults in emergency department clinical research: Strategies to achieve a critical goal. Acad Emerg Med 2022; 29:376-383. [PMID: 34582613 PMCID: PMC8958170 DOI: 10.1111/acem.14386] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/13/2022]
Abstract
Medical research across all fields has historically excluded older adults (aged 65 years and older). Because older adults have a higher burden of chronic illness, respond differently to treatment, and are more prone to medication side effects, the results of current research may not be applicable to this important population. To address this major research deficiency, the National Institutes of Health established the Inclusion Across the Lifespan policy, effective January 2019. We present important considerations and proven strategies for successful inclusion of older adults in emergency care research relating to study design, participant recruitment and retention, and sources of support for investigators.
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Affiliation(s)
| | | | | | - Ula Hwang
- Department of Emergency Medicine, Yale School of Medicine, New Haven CT,Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, NY
| | | | - Manish N. Shah
- BarbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tony Rosen
- Department of Emergency Medicine, Division of Geriatric Emergency Medicine, New York-Presbyterian Hospital / Weill Cornell Medical Center, New York, NY
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