title: Postdischarge Communication Between Home Health Nurses and Physicians: Measurement, Quality, and Outcomes.
abstract: OBJECTIVE
  To use natural language processing (NLP) of text from electronic medical records (EMRs) to identify failed communication attempts between home health nurses and physicians, to identify predictors of communication failure, and to assess the association between communication failure and hospital readmission.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Visiting Nurse Service of New York (VNSNY), the nation's largest freestanding home health agency.
  
  
  METHODS
  Medicare beneficiaries with congestive heart failure who received home health care from VNSNY after hospital discharge in 2008-09 (N = 5,698).
  
  
  METHODS
  Patient-level measures of communication failure and risk-adjusted 30-day all-cause readmission.
  
  
  RESULTS
  Identification of failed communication attempts using NLP had high external validity (kappa = 0.850, P < .001). A mean of 8% of communication attempts failed per episode of home care; failure rates were higher for black patients and lower for patients from higher median income ZIP codes. The association between communication failure and readmission was not significant with adjustment for patient, nurse, physician, and hospital factors.
  
  
  CONCLUSIONS
  NLP of EMRs can be used to identify failed communication attempts between home health nurses and physicians, but other variables mostly explained the association between communication failure and readmission. Communication failures may contribute to readmissions in more-serious clinical situations, an association that this study may have been underpowered to detect.
authors.affiliation: Weill Cornell Medical College, New York City, New York.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Press
authors.affiliation: Weill Cornell Medical College, New York City, New York.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Gerber
authors.affiliation: Visiting Nurse Service of New York, New York City, New York.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Peng
authors.affiliation: Weill Cornell Medical College, New York City, New York.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Pesko
authors.affiliation: Visiting Nurse Service of New York, New York City, New York.
authors.forename: Penny H
authors.initials: PH
authors.lastname: Feldman
authors.affiliation: Weill Cornell Medical College, New York City, New York.
authors.forename: Karin
authors.initials: K
authors.lastname: Ouchida
authors.affiliation: Visiting Nurse Service of New York, New York City, New York.
authors.forename: Sridevi
authors.initials: S
authors.lastname: Sridharan
authors.affiliation: Weill Cornell Medical College, New York City, New York.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Bao
authors.affiliation: Visiting Nurse Service of New York, New York City, New York.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Barron
authors.affiliation: Weill Cornell Medical College, New York City, New York.
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
mesh_terms: D000369:Aged, 80 and over; D000465:Algorithms; D057286:Electronic Health Records; D005260:Female; D006333:Heart Failure / Q000451:nursing*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D006278:Medicare; D009323:Natural Language Processing; D009518:New York; D064691:Nurses, Community Health; D010820:Physicians; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States
keywords: care coordination; home health care; natural language processing; readmission