We have located links that may give you full text access.
Using the Electronic Medical Record to Identify Patients at High Risk for Frequent Emergency Department Visits and High System Costs.
American Journal of Medicine 2017 January 6
BACKGROUND: A small proportion of patients account for a high proportion of healthcare use. Accurate preemptive identification may facilitate tailored intervention. We sought to determine whether machine learning techniques using text from a family practice electronic medical record can be used to predict future high emergency department use and total costs by patients who are not yet high emergency department users or high cost to the healthcare system.
METHODS: Text from fields of the cumulative patient profile within an electronic medical record of 43,111 patients was indexed. Separate training and validation cohorts were created. After processing, 11,905 words were used to fit a logistic regression model. The primary outcomes of interest in the 12 months after prediction were 3 or more emergency department visits and being in the top 5% in healthcare expenditures. Outcomes were assessed through linkage to administrative databases housed at the Institute for Clinical Evaluative Sciences.
RESULTS: In the model to predict frequent emergency department visits, after excluding patients who were high emergency department users in the previous year, the area under the receiver operating characteristic curve was 0.71. By using the same methodology, the model to predict the top 5% in total system costs had an area under the receiver operating characteristic curve of 0.76.
CONCLUSIONS: Machine learning techniques can be applied to analyze free text contained in electronic medical records. This dataset is more predictive of patients who will generate future high costs than future emergency department visits. It remains to be seen whether these predictions can be used to reduce costs by early interventions in this cohort of patients.
METHODS: Text from fields of the cumulative patient profile within an electronic medical record of 43,111 patients was indexed. Separate training and validation cohorts were created. After processing, 11,905 words were used to fit a logistic regression model. The primary outcomes of interest in the 12 months after prediction were 3 or more emergency department visits and being in the top 5% in healthcare expenditures. Outcomes were assessed through linkage to administrative databases housed at the Institute for Clinical Evaluative Sciences.
RESULTS: In the model to predict frequent emergency department visits, after excluding patients who were high emergency department users in the previous year, the area under the receiver operating characteristic curve was 0.71. By using the same methodology, the model to predict the top 5% in total system costs had an area under the receiver operating characteristic curve of 0.76.
CONCLUSIONS: Machine learning techniques can be applied to analyze free text contained in electronic medical records. This dataset is more predictive of patients who will generate future high costs than future emergency department visits. It remains to be seen whether these predictions can be used to reduce costs by early interventions in this cohort of patients.
Full text links
Related Resources
Trending Papers
Review article: Recent advances in ascites and acute kidney injury management in cirrhosis.Alimentary Pharmacology & Therapeutics 2024 March 26
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app