title: Sentiment Measured in Hospital Discharge Notes Is Associated with Readmission and Mortality Risk: An Electronic Health Record Study.
abstract: Natural language processing tools allow the characterization of sentiment--that is, terms expressing positive and negative emotion--in text. Applying such tools to electronic health records may provide insight into meaningful patient or clinician features not captured in coded data alone. We performed sentiment analysis on 2,484 hospital discharge notes for 2,010 individuals from a psychiatric inpatient unit, as well as 20,859 hospital discharges for 15,011 individuals from general medical units, in a large New England health system between January 2011 and 2014. The primary measures of sentiment captured intensity of subjective positive or negative sentiment expressed in the discharge notes. Mean scores were contrasted between sociodemographic and clinical groups in mixed effects regression models. Discharge note sentiment was then examined for association with risk for readmission in Cox regression models. Discharge notes for individuals with greater medical comorbidity were modestly but significantly lower in positive sentiment among both psychiatric and general medical cohorts (p<0.001 in each). Greater positive sentiment at discharge was associated with significantly decreased risk of hospital readmission in each cohort (~12% decrease per standard deviation above the mean). Automated characterization of discharge notes in terms of sentiment identifies differences between sociodemographic groups, as well as in clinical outcomes, and is not explained by differences in diagnosis. Clinician sentiment merits investigation to understand why and how it reflects or impacts outcomes.
authors: Center for Experimental Drugs and Diagnostics, Department of Psychiatry and Center for Human Genetic Research, Massachusetts General Hospital, 185 Cambridge St, 6th Floor, Boston, MA 02114, United States of America.
authors: Thomas H
authors: TH
authors: McCoy
authors: Center for Experimental Drugs and Diagnostics, Department of Psychiatry and Center for Human Genetic Research, Massachusetts General Hospital, 185 Cambridge St, 6th Floor, Boston, MA 02114, United States of America; Partners Research Computing, Partners HealthCare System, One Constitution Center, Boston, MA 02129, United States of America.
authors: Victor M
authors: VM
authors: Castro
authors: Center for Experimental Drugs and Diagnostics, Department of Psychiatry and Center for Human Genetic Research, Massachusetts General Hospital, 185 Cambridge St, 6th Floor, Boston, MA 02114, United States of America; Partners Research Computing, Partners HealthCare System, One Constitution Center, Boston, MA 02129, United States of America.
authors: Andrew
authors: A
authors: Cagan
authors: Center for Experimental Drugs and Diagnostics, Department of Psychiatry and Center for Human Genetic Research, Massachusetts General Hospital, 185 Cambridge St, 6th Floor, Boston, MA 02114, United States of America.
authors: Ashlee M
authors: AM
authors: Roberson
authors: Department of Medicine, Brigham and Women's Hospital, Suite 255, New Research Building, 77 Avenue Louis Pasteur, Boston, MA 02115, United States of America.
authors: Isaac S
authors: IS
authors: Kohane
authors: Center for Experimental Drugs and Diagnostics, Department of Psychiatry and Center for Human Genetic Research, Massachusetts General Hospital, 185 Cambridge St, 6th Floor, Boston, MA 02114, United States of America.
authors: Roy H
authors: RH
authors: Perlis
mesh_terms: D057286:Electronic Health Records; D004644:Emotions; D005006:Ethnicity; D005260:Female; D006761:Hospitals; D006801:Humans; D007341:Insurance; D007902:Length of Stay; D008297:Male; D009026:Mortality; D009323:Natural Language Processing; D010351:Patient Discharge; D010359:Patient Readmission; D010820:Physicians