title: Use of an artificial neural network (ANN) for classifying nursing care needed, using incomplete input data.
abstract: BACKGROUND
  In German nursing insurance, the act of classifying the client into four categories of disability is based on legally defined distinct criteria. When classifying deceased persons it is often impossible to collect all the required information.
  
  
  OBJECTIVE
  We aimed to determine the ability of an artificial neural network (ANN) to calculate the category of disability, to investigate the response of the ANN to input items of different nature, quantity and data quality, and to estimate the minimum number of training data required.
  
  
  METHODS
  The investigation was conducted as a retrospective observational study.
  
  
  METHODS
  The analysis was based on routine records of 14000 adult clients of the nursing insurance. Several ANNs were trained, varying nature, number and quality of the input items as well as the size of the training data set. Each ANN's classification competence was tested on independent validation data, judging the ANN's conformance to the result of the individual expert assessment, using kappa statistics.
  
  
  RESULTS
  Fed with all 30 input items available, the net classified 80% of cases correctly (weighted kappa = 0.78). Using three input items, weighted kappa was 0.63. Severe misclassification (deviation by more than one category in either direction) ranged between 0.2% (all 30 input items) and 3.7% (3/30 items). The less complete the individual input items were, the less accurate was the net's estimate. A 20% rate of missing values was well tolerated. A training set comprising 500 cases was adequate.
  
  
  CONCLUSIONS
  The input item set inherits redundancy. The ANN's ability to correctly respond to subsets of input items makes it a powerful tool in quality control. In the categorization of deceased persons when only an incomplete input item set is available, the ANN can achieve satisfactory results.
authors.affiliation: Medizinischer Dienst der Krankenversicherung Westfalen-Lippe (MDK WL), Münster, Germany. erik.michel@t-online.de
authors.forename: E
authors.initials: E
authors.lastname: Michel
authors.forename: B
authors.initials: B
authors.lastname: Zernikow
authors.forename: S A
authors.initials: SA
authors.lastname: Wichert
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D004185:Disability Evaluation; D005069:Evaluation Studies as Topic; D005858:Germany; D006801:Humans; D018868:Insurance, Disability / Q000145:classification*; D016571:Neural Networks, Computer; D009732:Nursing Care; D012189:Retrospective Studies; D012986:Software Validation