title: Studying Associations Between Heart Failure Self-Management and Rehospitalizations Using Natural Language Processing.
abstract: This study developed an innovative natural language processing algorithm to automatically identify heart failure (HF) patients with ineffective self-management status (in the domains of diet, physical activity, medication adherence, and adherence to clinician appointments) from narrative discharge summary notes. We also analyzed the association between self-management status and preventable 30-day hospital readmissions. Our natural language system achieved relatively high accuracy ( F-measure = 86.3%; precision = 95%; recall = 79.2%) on a testing sample of 300 notes annotated by two human reviewers. In a sample of 8,901 HF patients admitted to our healthcare system, 14.4% ( n = 1,282) had documentation of ineffective HF self-management. Adjusted regression analyses indicated that presence of any skill-related self-management deficit (odds ratio [OR] = 1.3, 95% confidence interval [CI] = [1.1, 1.6]) and non-specific ineffective self-management (OR = 1.5, 95% CI = [1.2, 2]) was significantly associated with readmissions. We have demonstrated the feasibility of identifying ineffective HF self-management from electronic discharge summaries with natural language processing.
authors.affiliation: 1 Harvard Medical School, Boston, MA, USA.|2 Brigham Women's Health Hospital, Boston, MA, USA.
authors.forename: Maxim
authors.initials: M
authors.lastname: Topaz
authors.affiliation: 3 The University of Texas at Austin, TX, USA.
authors.forename: Kavita
authors.initials: K
authors.lastname: Radhakrishnan
authors.affiliation: 2 Brigham Women's Health Hospital, Boston, MA, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Blackley
authors.affiliation: 2 Brigham Women's Health Hospital, Boston, MA, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Lei
authors.affiliation: 4 Partners Healthcare Inc, Boston, MA, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lai
authors.affiliation: 1 Harvard Medical School, Boston, MA, USA.|2 Brigham Women's Health Hospital, Boston, MA, USA.|4 Partners Healthcare Inc, Boston, MA, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Zhou
keywords: cardiovascular; clinical focus; diet; health behavior/symptom focus; health screening behaviors; heart failure; medication adherence; natural language processing; patient compliance; self-care; sodium restricted; therapeutic medications