Free-Text Documentation of Dementia Symptoms in Home Healthcare: A Natural Language Processing Study.
Alzheimer’s disease
dementia
electronic health record
home health care
natural language processing
Journal
Gerontology & geriatric medicine
ISSN: 2333-7214
Titre abrégé: Gerontol Geriatr Med
Pays: United States
ID NLM: 101662571
Informations de publication
Date de publication:
Historique:
received:
30
05
2020
revised:
18
08
2020
accepted:
21
08
2020
entrez:
8
10
2020
pubmed:
9
10
2020
medline:
9
10
2020
Statut:
epublish
Résumé
Little is known about symptom documentation related to Alzheimer's disease and related dementias (ADRD) by home healthcare (HHC) clinicians. This study: (1) developed a natural language processing (NLP) algorithm that identifies common neuropsychiatric symptoms of ADRD in HHC free-text clinical notes; (2) described symptom clusters and hospitalization or emergency department (ED) visit rates for patients with and without these symptoms. We examined a corpus of -2.6 million free-text notes for 112,237 HHC episodes among 89,459 patients admitted to a non-profit HHC agency for post-acute care with any diagnosis. We used NLP software (NimbleMiner) to construct indicators of six neuropsychiatric symptoms. Structured HHC assessment data were used to identify known ADRD diagnoses and construct measures of hospitalization/ED use during HHC. Neuropsychiatric symptoms were documented for 40% of episodes. Common clusters included impaired memory, anxiety and/or depressed mood. One in three episodes without an ADRD diagnosis had documented symptoms. Hospitalization/ED rates increased with one or more symptoms present. HHC providers should examine episodes with neuropsychiatric symptoms but no ADRD diagnoses to determine whether ADRD diagnosis was missed or to recommend ADRD evaluation. NLP-generated symptom indicators can help to identify high-risk patients for targeted interventions.
Sections du résumé
BACKGROUND
BACKGROUND
Little is known about symptom documentation related to Alzheimer's disease and related dementias (ADRD) by home healthcare (HHC) clinicians.
OBJECTIVE
OBJECTIVE
This study: (1) developed a natural language processing (NLP) algorithm that identifies common neuropsychiatric symptoms of ADRD in HHC free-text clinical notes; (2) described symptom clusters and hospitalization or emergency department (ED) visit rates for patients with and without these symptoms.
METHOD
METHODS
We examined a corpus of -2.6 million free-text notes for 112,237 HHC episodes among 89,459 patients admitted to a non-profit HHC agency for post-acute care with any diagnosis. We used NLP software (NimbleMiner) to construct indicators of six neuropsychiatric symptoms. Structured HHC assessment data were used to identify known ADRD diagnoses and construct measures of hospitalization/ED use during HHC.
RESULTS
RESULTS
Neuropsychiatric symptoms were documented for 40% of episodes. Common clusters included impaired memory, anxiety and/or depressed mood. One in three episodes without an ADRD diagnosis had documented symptoms. Hospitalization/ED rates increased with one or more symptoms present.
CONCLUSION
CONCLUSIONS
HHC providers should examine episodes with neuropsychiatric symptoms but no ADRD diagnoses to determine whether ADRD diagnosis was missed or to recommend ADRD evaluation. NLP-generated symptom indicators can help to identify high-risk patients for targeted interventions.
Identifiants
pubmed: 33029550
doi: 10.1177/2333721420959861
pii: 10.1177_2333721420959861
pmc: PMC7520927
doi:
Types de publication
Journal Article
Langues
eng
Pagination
2333721420959861Subventions
Organisme : NIA NIH HHS
ID : R21 AG065753
Pays : United States
Informations de copyright
© The Author(s) 2020.
Déclaration de conflit d'intérêts
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Références
J Biomed Inform. 2019 Feb;90:103103
pubmed: 30639392
Alzheimers Dement. 2013 Mar;9(2):208-45
pubmed: 23507120
Int J Geriatr Psychiatry. 2014 Jul;29(7):682-93
pubmed: 24458456
J Am Geriatr Soc. 2008 Mar;56(3):523-8
pubmed: 18179497
Int Psychogeriatr. 2019 Jun;31(6):799-813
pubmed: 30466499
Int Psychogeriatr. 2019 Jan;31(1):91-99
pubmed: 29720290
Artif Intell Med. 2016 Jan;66:29-39
pubmed: 26481140
Int Psychogeriatr. 2018 Jan;30(1):103-113
pubmed: 28927477
J Am Geriatr Soc. 2015 Jun;63(6):1203-8
pubmed: 26032224
Stud Health Technol Inform. 2018;250:164-168
pubmed: 29857421
J Am Geriatr Soc. 2000 Mar;48(3):300-4
pubmed: 10733057
Stud Health Technol Inform. 2019 Aug 21;264:803-807
pubmed: 31438035
J Allergy Clin Immunol. 2019 Jul;144(1):129-134
pubmed: 30721764
J Am Med Inform Assoc. 2016 Sep;23(5):1007-15
pubmed: 26911811
Alzheimers Dement. 2013 Jan;9(1):30-8
pubmed: 23305822
J Am Geriatr Soc. 2018 Feb;66(2):339-345
pubmed: 29192967
Int J Geriatr Psychiatry. 2018 Oct;33(10):1361-1369
pubmed: 29979473
Stud Health Technol Inform. 2019 Aug 21;264:798-802
pubmed: 31438034
Biochem Med (Zagreb). 2012;22(3):276-82
pubmed: 23092060
Int J Care Coord. 2017 Dec;20(4):123-134
pubmed: 29607051
J Comp Eff Res. 2014 May;3(3):245-57
pubmed: 24969152
Res Gerontol Nurs. 2018 Jul 1;11(4):181-189
pubmed: 30036404
J Alzheimers Dis. 2015;49(3):617-31
pubmed: 26484931
Health Serv Res. 2018 Feb;53(1):556-579
pubmed: 28083879
BMC Geriatr. 2016 Jul 11;16:138
pubmed: 27400711
Stud Health Technol Inform. 2019 Aug 21;264:1056-1060
pubmed: 31438086
Contemp Clin Trials. 2018 Aug;71:103-112
pubmed: 29783091
Curr Opin Neurol. 2002 Aug;15(4):445-50
pubmed: 12151841
Yearb Med Inform. 2008;:128-44
pubmed: 18660887
BMC Neurol. 2014 May 07;14:101
pubmed: 24885474
Am J Geriatr Psychiatry. 2015 Jul;23(7):698-708
pubmed: 25771267
Am J Geriatr Psychiatry. 2014 Apr;22(4):398-414
pubmed: 24502822
IEEE Trans Vis Comput Graph. 2014 Dec;20(12):1983-92
pubmed: 26356912
Int J Geriatr Psychiatry. 2019 Jan;34(1):114-121
pubmed: 30246266
Int J Psychiatry Med. 2016;51(2):171-81
pubmed: 26941207
Appl Clin Inform. 2017 Feb 22;8(1):191-205
pubmed: 28224163
J Am Geriatr Soc. 2017 Apr;65(4):808-814
pubmed: 28152160
Contemp Clin Trials. 2017 Nov;62:27-36
pubmed: 28800895
Arch Gerontol Geriatr. 2014 Jul-Aug;59(1):162-8
pubmed: 24661400
Alzheimers Dement. 2017 Oct;13(10):1174-1178
pubmed: 28886338
Arch Neurol. 2002 Nov;59(11):1764-7
pubmed: 12433264
PLoS One. 2012;7(8):e42751
pubmed: 22905169
Alzheimers Dement. 2011 May;7(3):280-92
pubmed: 21514248