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Menteş N, Çakmak MA, Kurt ME. Estimation of service length with the machine learning algorithms and neural networks for patients who receiving home health care. EVALUATION AND PROGRAM PLANNING 2023; 100:102324. [PMID: 37290209 DOI: 10.1016/j.evalprogplan.2023.102324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
The main purpose of the study is to develop an estimation model using machine learning algorithms and to ensure the effective and efficient implementation of home health care service planning in hospitals with these algorithms. The necessary approvals for the study were obtained. The data set was created by obtaining patient data (except for data such as Turkish Republic identification number) from 14 hospitals providing Home Health Care Services in the city of Diyarbakır. The data set was subjected to necessary pre-processing and descriptive statistics were applied. For the estimation model, Decision Tree, Random Forest and Multi-layer Perceptron Neural Network algorithms were used. It was found that the number of days of home health care service, which the patients received, varied depending on their age and gender. It was observed that the patients were generally in the disease groups that required Physiotherapy and Rehabilitation treatments. It was determined that the length of service for patients can be predicted with a high reliability rate (Multi-Layer Model Acc: 90.4%, Decision Tree Model Acc: 86.4%, Random Forest Model Acc: 88.5%) using machine learning algorithms. In the light of the findings and data patterns obtained in the study, it is thought that effective and efficient planning will be made in terms of health management. In addition, it is believed that estimating the average length of service for patients will contribute to strategic planning of human resources for health, and to reducing medical consumables, drugs and hospital expenses.
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Affiliation(s)
- Nurettin Menteş
- Inonu University, Malatya Vocational School, Malatya, Turkey.
| | - Mehmet Aziz Çakmak
- Dicle University, Faculty of Economics and Administrative Sciences, Department of Health Management, Diyarbakır, Turkey.
| | - Mehmet Emin Kurt
- Dicle University, Faculty of Economics and Administrative Sciences, Department of Health Management, Diyarbakır, Turkey.
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Bogler O, Kirkwood D, Austin PC, Jones A, Sinn CLJ, Okrainec K, Costa A, Lapointe-Shaw L. Recent functional decline and outpatient follow-up after hospital discharge: a cohort study. BMC Geriatr 2023; 23:550. [PMID: 37697250 PMCID: PMC10496187 DOI: 10.1186/s12877-023-04192-7] [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: 04/04/2023] [Accepted: 07/24/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Functional decline is common following acute hospitalization and is associated with hospital readmission, institutionalization, and mortality. People with functional decline may have difficulty accessing post-discharge medical care, even though early physician follow-up has the potential to prevent poor outcomes and is integral to high-quality transitional care. We sought to determine whether recent functional decline was associated with lower rates of post-discharge physician follow-up, and whether this association changed during the COVID-19 pandemic, given that both functional decline and COVID-19 may affect access to post-discharge care. METHOD We conducted a retrospective cohort study using health administrative data from Ontario, Canada. We included patients over 65 who were discharged from an acute care facility during March 1st, 2019 - January 31st, 2020 (pre-COVID-19 period), and March 1st, 2020 - January 31st, 2021 (COVID-19 period), and who were assessed for home care while in hospital. Patients with and without functional decline were compared. Our primary outcome was any physician follow-up visit within 7 days of discharge. We used propensity score weighting to compare outcomes between those with and without functional decline. RESULTS Our study included 21,771 (pre-COVID) and 17,248 (COVID) hospitalized patients, of whom 15,637 (71.8%) and 12,965 (75.2%) had recent functional decline. Pre-COVID, there was no difference in physician follow-up within 7 days of discharge (Functional decline 45.0% vs. No functional decline 44.0%; RR = 1.02, 95% CI 0.98-1.06). These results did not change in the COVID-19 period (Functional decline 51.1% vs. No functional decline 49.4%; RR = 1.03, 95% CI 0.99-1.08, Z-test for interaction p = 0.72). In the COVID-19 cohort, functional decline was associated with having a 7-day physician virtual visit (RR 1.15; 95% CI 1.08-1.24) and a 7-day physician home visit (RR 1.64; 95% CI 1.10-2.43). CONCLUSIONS Functional decline was not associated with reduced 7-day post-discharge physician follow-up in either the pre-COVID-19 or COVID-19 periods. In the COVID-19 period, functional decline was positively associated with 7-day virtual and home-visit follow-up.
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Affiliation(s)
- Orly Bogler
- Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - David Kirkwood
- Institute for Clinical Evaluative Sciences McMaster, Hamilton, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Aaron Jones
- Institute for Clinical Evaluative Sciences McMaster, Hamilton, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Chi-Ling Joanna Sinn
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Karen Okrainec
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Toronto General Hospital Research Institute, Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Andrew Costa
- Institute for Clinical Evaluative Sciences McMaster, Hamilton, Canada
| | - Lauren Lapointe-Shaw
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, Department of Medicine, University Health Network, Toronto, ON, Canada
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Nuutinen M, Haukka J, Virkkula P, Torkki P, Toppila-Salmi S. Using machine learning for the personalised prediction of revision endoscopic sinus surgery. PLoS One 2022; 17:e0267146. [PMID: 35486626 PMCID: PMC9053825 DOI: 10.1371/journal.pone.0267146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Revision endoscopic sinus surgery (ESS) is often considered for chronic rhinosinusitis (CRS) if maximal conservative treatment and baseline ESS prove insufficient. Emerging research outlines the risk factors of revision ESS. However, accurately predicting revision ESS at the individual level remains uncertain. This study aims to examine the prediction accuracy of revision ESS and to identify the effects of risk factors at the individual level. METHODS We collected demographic and clinical variables from the electronic health records of 767 surgical CRS patients ≥16 years of age. Revision ESS was performed on 111 (14.5%) patients. The prediction accuracy of revision ESS was examined by training and validating different machine learning models, while the effects of variables were analysed using the Shapley values and partial dependence plots. RESULTS The logistic regression, gradient boosting and random forest classifiers performed similarly in predicting revision ESS. Area under the receiving operating characteristic curve (AUROC) values were 0.744, 0.741 and 0.730, respectively, using data collected from the baseline visit until six months after baseline ESS. The length of time during which data were collected improved the prediction performance. For data collection times of 0, 3, 6 and 12 months after baseline ESS, AUROC values for the logistic regression were 0.682, 0.715, 0.744 and 0.784, respectively. The number of visits before or after baseline ESS, the number of days from the baseline visit to the baseline ESS, patient age, CRS with nasal polyps (CRSwNP), asthma, non-steroidal anti-inflammatory drug exacerbated respiratory disease and immunodeficiency or suspicion of it all associated with revision ESS. Patient age and number of visits before baseline ESS carried non-linear effects for predictions. CONCLUSIONS Intelligent data analysis identified important predictors of revision ESS at the individual level, such as the frequency of clinical visits, patient age, Type 2 high diseases and immunodeficiency or a suspicion of it.
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Affiliation(s)
- Mikko Nuutinen
- Haartman Institute, University of Helsinki, Helsinki, Finland
- Nordic Healthcare Group, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Paula Virkkula
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Paulus Torkki
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Sanna Toppila-Salmi
- Haartman Institute, University of Helsinki, Helsinki, Finland
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- * E-mail:
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Patterns of home care assessment and service provision before and during the COVID-19 pandemic in Ontario, Canada. PLoS One 2022; 17:e0266160. [PMID: 35353856 PMCID: PMC8966998 DOI: 10.1371/journal.pone.0266160] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/16/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The objective was to compare home care episode, standardised assessment, and service patterns in Ontario's publicly funded home care system during the first wave of the COVID-19 pandemic (i.e., March to September 2020) using the previous year as reference. STUDY DESIGN AND SETTING We plotted monthly time series data from March 2019 to September 2020 for home care recipients in Ontario, Canada. Home care episodes were linked to interRAI Home Care assessments, interRAI Contact Assessments, and home care services. Health status measures from the patient's most recent interRAI assessment were used to stratify the receipt of personal support, nursing, and occupational or physical therapy services. Significant level and slope changes were detected using Poisson, beta, and linear regression models. RESULTS The March to September 2020 period was associated with significantly fewer home care admissions, discharges, and standardised assessments. Among those assessed with the interRAI Home Care assessment, significantly fewer patients received any personal support services. Among those assessed with either interRAI assessment and identified to have rehabilitation needs, significantly fewer patients received any therapy services. Among patients receiving services, patients received significantly fewer hours of personal support and fewer therapy visits per month. By September 2020, the rate of admissions and services had mostly returned to pre-pandemic levels, but completion of standardised assessments lagged behind. CONCLUSION The first wave of the COVID-19 pandemic was associated with substantial changes in Ontario's publicly funded home care system. Although it may have been necessary to prioritise service delivery during a crisis situation, standardised assessments are needed to support individualised patient care and system-level monitoring. Given the potential disruptions to home care services, future studies should examine the impact of the pandemic on the health and well-being of home care recipients and their caregiving networks.
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Seibert K, Domhoff D, Bruch D, Schulte-Althoff M, Fürstenau D, Biessmann F, Wolf-Ostermann K. Application Scenarios for Artificial Intelligence in Nursing Care: Rapid Review. J Med Internet Res 2021; 23:e26522. [PMID: 34847057 PMCID: PMC8669587 DOI: 10.2196/26522] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/21/2021] [Accepted: 10/08/2021] [Indexed: 12/23/2022] Open
Abstract
Background Artificial intelligence (AI) holds the promise of supporting nurses’ clinical decision-making in complex care situations or conducting tasks that are remote from direct patient interaction, such as documentation processes. There has been an increase in the research and development of AI applications for nursing care, but there is a persistent lack of an extensive overview covering the evidence base for promising application scenarios. Objective This study synthesizes literature on application scenarios for AI in nursing care settings as well as highlights adjacent aspects in the ethical, legal, and social discourse surrounding the application of AI in nursing care. Methods Following a rapid review design, PubMed, CINAHL, Association for Computing Machinery Digital Library, Institute of Electrical and Electronics Engineers Xplore, Digital Bibliography & Library Project, and Association for Information Systems Library, as well as the libraries of leading AI conferences, were searched in June 2020. Publications of original quantitative and qualitative research, systematic reviews, discussion papers, and essays on the ethical, legal, and social implications published in English were included. Eligible studies were analyzed on the basis of predetermined selection criteria. Results The titles and abstracts of 7016 publications and 704 full texts were screened, and 292 publications were included. Hospitals were the most prominent study setting, followed by independent living at home; fewer application scenarios were identified for nursing homes or home care. Most studies used machine learning algorithms, whereas expert or hybrid systems were entailed in less than every 10th publication. The application context of focusing on image and signal processing with tracking, monitoring, or the classification of activity and health followed by care coordination and communication, as well as fall detection, was the main purpose of AI applications. Few studies have reported the effects of AI applications on clinical or organizational outcomes, lacking particularly in data gathered outside laboratory conditions. In addition to technological requirements, the reporting and inclusion of certain requirements capture more overarching topics, such as data privacy, safety, and technology acceptance. Ethical, legal, and social implications reflect the discourse on technology use in health care but have mostly not been discussed in meaningful and potentially encompassing detail. Conclusions The results highlight the potential for the application of AI systems in different nursing care settings. Considering the lack of findings on the effectiveness and application of AI systems in real-world scenarios, future research should reflect on a more nursing care–specific perspective toward objectives, outcomes, and benefits. We identify that, crucially, an advancement in technological-societal discourse that surrounds the ethical and legal implications of AI applications in nursing care is a necessary next step. Further, we outline the need for greater participation among all of the stakeholders involved.
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Affiliation(s)
- Kathrin Seibert
- Institute of Public Health and Nursing Research, High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Dominik Domhoff
- Institute of Public Health and Nursing Research, High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Dominik Bruch
- Auf- und Umbruch im Gesundheitswesen UG, Bonn, Germany
| | - Matthias Schulte-Althoff
- School of Business and Economics, Department of Information Systems, Freie Universität Berlin, Einstein Center Digital Future, Berlin, Germany
| | - Daniel Fürstenau
- Department of Digitalization, Copenhagen Business School, Frederiksberg, Denmark.,Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Biessmann
- Faculty VI - Informatics and Media, Beuth University of Applied Sciences, Einstein Center Digital Future, Berlin, Germany
| | - Karin Wolf-Ostermann
- Institute of Public Health and Nursing Research, High Profile Area Health Sciences, University of Bremen, Bremen, Germany
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Elouni J, Ellouzi H, Ltifi H, Ayed MB. Intelligent health monitoring system modeling based on machine learning and agent technology. ACTA ACUST UNITED AC 2020. [DOI: 10.3233/mgs-200329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Jihed Elouni
- Research Groups in Intelligent Machines, University of Sfax, National School of Engineers, Sfax, Tunisia
| | - Hamdi Ellouzi
- Research Groups in Intelligent Machines, University of Sfax, National School of Engineers, Sfax, Tunisia
| | - Hela Ltifi
- Research Groups in Intelligent Machines, University of Sfax, National School of Engineers, Sfax, Tunisia
- Computer Sciences and Mathematics Department, Faculty of Sciences and Techniques of SidiBouzid, University of Kairouan, Tunisia
| | - Mounir Ben Ayed
- Research Groups in Intelligent Machines, University of Sfax, National School of Engineers, Sfax, Tunisia
- Computer Sciences and Communication Department, Faculty of Sciences of Sfax, University of Sfax, Tunisia
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Nuutinen M, Leskelä RL, Torkki P, Suojalehto E, Tirronen A, Komssi V. Developing and validating models for predicting nursing home admission using only RAI-HC instrument data. Inform Health Soc Care 2019; 45:292-308. [PMID: 31696753 DOI: 10.1080/17538157.2019.1656212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE In recent years research has identified important predictors for nursing home admission (NHA). However, as far as we know, the previous risk models use complex variable sets from many sources and the output is a single risk value. The objective of this study was to develop an NHA risk model with a variable set from single data source and richer output information. METHODS In this study, we developed a model selecting variables only from the RAI-HC (Resident Assessment Instrument - Home Care) system. Furthermore, we used principal component analysis and K-means clustering to target proper interventions for high-risk clients. RESULTS The performance of the model was close to the complex previous model (recall [Formula: see text] vs. [Formula: see text] and specificity [Formula: see text] vs. [Formula: see text]). For the risk clients, three intervention clusters (deficiency in physical functionality, deficiency in cognitive functionality and depression and mood disorders) were found. CONCLUSION The NHA risk model and intervention clusters are important because they enable the identification of proper interventions for the right clients. The fact that the model with RAI-HC data alone was accurate enough simplifies the integration of the NHA risk model into practice because it uses data from one system and the algorithm can be integrated easily into the source system.
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Affiliation(s)
- M Nuutinen
- Nordic Healthcare Group , Helsinki, Finland
| | | | - P Torkki
- Nordic Healthcare Group , Helsinki, Finland
| | | | | | - V Komssi
- Nordic Healthcare Group , Helsinki, Finland
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de Stampa M, Cerase V, Bagaragaza E, Lys E, Alitta Q, Gammelin C, Henrard JC. Implementation of a Standardized Comprehensive Assessment Tool in France: A Case Using the InterRAI Instruments. Int J Integr Care 2018; 18:5. [PMID: 30127689 PMCID: PMC6095084 DOI: 10.5334/ijic.3297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 03/26/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The improvement of quality of care requires a standardized and comprehensive assessment tool but implementation is challenging. PURPOSE We have reported on the development of the interRAI instruments in France from the onset to the mandatory use at the national level. We also have identified in the literature and in practices, incentives and barriers for the implementation of this integrated clinical information system in long term care. RESULTS Three periods in the interRAI instruments development were identified over the last twenty years. The first one was a research approach about improving quality of long term care. The second one was an experimental clinical use into an integrated care model with case management. The third one was a call for tenders issued by a French national agency, and the choice to use the interRAI-HC (Home Care) for all case managers. The main incentives and barriers that were identified include the national context, the target population, the providers involved and the impact on their practice, the interRAI instrument characteristics, training and leadership. CONCLUSION This historical overview of the development of interRAI instruments in France gives health care organizations pertinent information to guide the implementation of a standardized and comprehensive assessment tool.
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Affiliation(s)
- Matthieu de Stampa
- Assistance Publique Hôpitaux de Paris, Hospitalisation à Domicile, Unité Mixte de Recherche (UMR) 1168 INSERM, UVSQ, VIMA (Vieillissement et Maladies Chroniques), InterRAI France, Paris, FR
| | - Valérie Cerase
- Institut Maladie Alzheimer (IMA), Centre Départemental de Gérontologie, interRAI France, Marseille, FR
| | - Emmanuel Bagaragaza
- Pôle Recherche SPES « Soins Palliatifs En Société », Maison Médicale Jeanne Garnier, Unité Mixte de Recherche (UMR) 1168 INSERM, UVSQ, VIMA (Vieillissement et Maladies Chroniques), InterRAI France, Paris, FR
| | - Elodie Lys
- Centre Départemental de Gérontologie, InterRAI France, Marseille, FR
| | - Quentin Alitta
- Centre Départemental de Gérontologie, InterRAI France, Marseille, FR
| | - Cedric Gammelin
- Centre Départemental de Gérontologie, InterRAI France, Marseille, FR
| | - Jean-Claude Henrard
- Université de Versailles, Saint-Quentin en Yvelines, InterRAI France, Paris, FR
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Miles JD, Staples WH, Lee DJ. Attitudes About Cognitive Screening: A Survey of Home Care Physical Therapists. J Geriatr Phys Ther 2018; 42:294-303. [PMID: 29461340 DOI: 10.1519/jpt.0000000000000179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Home care physical therapists (PTs) are inconsistent regarding cognitive screening, possibly because screening tools were traditionally considered the domain of other home care disciplines, or because therapists perceive their dementia training to be inadequate. A cross sectional study was designed to survey home care therapists' attitudes and beliefs about the management of persons with dementia and to find out whether any specific cognitive tools or measures are currently used. METHODS A 5-point Likert-type survey was administered to home care PTs via an online survey. Three state home care associations and individual home care agencies agreed to share the survey link. The survey was also made available to American Physical Therapy Association members through the Home Health and Geriatric Section listservs. RESULTS AND DISCUSSION Two hundred fifty-one PTs opened the survey and 233 completed the survey. Respondents included 180 females and 53 males. Seventy-four had a bachelor's degree (BS), 53 held a master's degree (MS), 104 had achieved a doctor of physical therapy (DPT) or doctor of philosophy (PhD) degree, and 2 did not provide this information. Significant differences were found between those with the highest doctoral degrees and those with master's or bachelor's degrees (P = .01) regarding whether they were qualified to screen (strongly agree, agree) for cognitive deficits. Therapists with the highest degrees also attended continuing education for dementia training more than those with less formal education (P = .042.) Gender differences were found in 2 questions regarding positive outcomes (P = .010 and .42); for both questions, males were more likely to believe that dementia has a negative impact. Eighty-seven percent indicated that PTs are qualified (strongly agree, agree), but only 53% said that they possess the necessary skills (strongly agree, agree) to perform cognitive screens. Specialty certification revealed significant differences in several of the questions. No significance was found for any question regarding years of practice or years in home care. The Mini-Mental State Examination and the Clock Drawing Test were most frequently cited among PTs who conduct cognitive screening. CONCLUSIONS Physical therapists recognize that they are qualified to perform cognitive screening but may need additional training to utilize cognitive findings to enhance interventions and outcomes in home care. More research is needed to determine which screens are most relevant for therapist use and to examine the effect of cognitive screening on therapy outcomes.
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Affiliation(s)
- Jean D Miles
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut.,McLean Home Care & Hospice, Simsbury, Connecticut
| | - William H Staples
- College of Health Sciences, Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana
| | - Daniel J Lee
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut
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Nuutinen M, Leskelä RL, Suojalehto E, Tirronen A, Komssi V. Development and validation of classifiers and variable subsets for predicting nursing home admission. BMC Med Inform Decis Mak 2017; 17:39. [PMID: 28407806 PMCID: PMC5390435 DOI: 10.1186/s12911-017-0442-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/07/2017] [Indexed: 12/02/2022] Open
Abstract
Background In previous years a substantial number of studies have identified statistically important predictors of nursing home admission (NHA). However, as far as we know, the analyses have been done at the population-level. No prior research has analysed the prediction accuracy of a NHA model for individuals. Methods This study is an analysis of 3056 longer-term home care customers in the city of Tampere, Finland. Data were collected from the records of social and health service usage and RAI-HC (Resident Assessment Instrument - Home Care) assessment system during January 2011 and September 2015. The aim was to find out the most efficient variable subsets to predict NHA for individuals and validate the accuracy. The variable subsets of predicting NHA were searched by sequential forward selection (SFS) method, a variable ranking metric and the classifiers of logistic regression (LR), support vector machine (SVM) and Gaussian naive Bayes (GNB). The validation of the results was guaranteed using randomly balanced data sets and cross-validation. The primary performance metrics for the classifiers were the prediction accuracy and AUC (average area under the curve). Results The LR and GNB classifiers achieved 78% accuracy for predicting NHA. The most important variables were RAI MAPLE (Method for Assigning Priority Levels), functional impairment (RAI IADL, Activities of Daily Living), cognitive impairment (RAI CPS, Cognitive Performance Scale), memory disorders (diagnoses G30-G32 and F00-F03) and the use of community-based health-service and prior hospital use (emergency visits and periods of care). Conclusion The accuracy of the classifier for individuals was high enough to convince the officials of the city of Tampere to integrate the predictive model based on the findings of this study as a part of home care information system. Further work need to be done to evaluate variables that are modifiable and responsive to interventions.
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Affiliation(s)
- Mikko Nuutinen
- Nordic Healthcare Group, Vattuniemenranta 2, Helsinki, 00210, Finland.
| | | | | | | | - Vesa Komssi
- Nordic Healthcare Group, Vattuniemenranta 2, Helsinki, 00210, Finland
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Mao HF, Chang LH, Tsai AYJ, Huang WN, Wang J. Developing a Referral Protocol for Community-Based Occupational Therapy Services in Taiwan: A Logistic Regression Analysis. PLoS One 2016; 11:e0148414. [PMID: 26863544 PMCID: PMC4749289 DOI: 10.1371/journal.pone.0148414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 01/17/2016] [Indexed: 11/18/2022] Open
Abstract
Because resources for long-term care services are limited, timely and appropriate referral for rehabilitation services is critical for optimizing clients' functions and successfully integrating them into the community. We investigated which client characteristics are most relevant in predicting Taiwan's community-based occupational therapy (OT) service referral based on experts' beliefs. Data were collected in face-to-face interviews using the Multidimensional Assessment Instrument (MDAI). Community-dwelling participants (n = 221) ≥ 18 years old who reported disabilities in the previous National Survey of Long-term Care Needs in Taiwan were enrolled. The standard for referral was the judgment and agreement of two experienced occupational therapists who reviewed the results of the MDAI. Logistic regressions and Generalized Additive Models were used for analysis. Two predictive models were proposed, one using basic activities of daily living (BADLs) and one using instrumental ADLs (IADLs). Dementia, psychiatric disorders, cognitive impairment, joint range-of-motion limitations, fear of falling, behavioral or emotional problems, expressive deficits (in the BADL-based model), and limitations in IADLs or BADLs were significantly correlated with the need for referral. Both models showed high area under the curve (AUC) values on receiver operating curve testing (AUC = 0.977 and 0.972, respectively). The probability of being referred for community OT services was calculated using the referral algorithm. The referral protocol facilitated communication between healthcare professionals to make appropriate decisions for OT referrals. The methods and findings should be useful for developing referral protocols for other long-term care services.
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Affiliation(s)
- Hui-Fen Mao
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ling-Hui Chang
- Department of Occupational Therapy, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Athena Yi-Jung Tsai
- Department of Occupational Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ni Huang
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Jye Wang
- Department of Health Care Administration, Chang Jung Christian University, Tainan, Taiwan
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