An Automated Method for Identifying Individuals with a Lung Nodule Can Be Feasibly Implemented Across Health Systems.
BACKGROUND
The incidence of incidentally detected lung nodules is rapidly rising, but little is known about their management or associated patient outcomes. One barrier to studying lung nodule care is the inability to efficiently and reliably identify the cohort of interest (i.e. cases). Investigators at Kaiser Permanente Southern California (KPSC) recently developed an automated method to identify individuals with an incidentally discovered lung nodule, but the feasibility of implementing this method across other health systems is unknown.


METHODS
A random sample of Group Health (GH) members who had a computed tomography in 2012 underwent chart review to determine if a lung nodule was documented in the radiology report. A previously developed natural language processing (NLP) algorithm was implemented at our site using only knowledge of the key words, qualifiers, excluding terms, and the logic linking these parameters.


RESULTS
Among 499 subjects, 156 (31%, 95% confidence interval [CI] 27-36%) had an incidentally detected lung nodule. NLP identified 189 (38%, 95% CI 33-42%) individuals with a nodule. The accuracy of NLP at GH was similar to its accuracy at KPSC: sensitivity 90% (95% CI 85-95%) and specificity 86% (95% CI 82-89%) versus sensitivity 96% (95% CI 88-100%) and specificity 86% (95% CI 75-94%).


CONCLUSIONS
Automated methods designed to identify individuals with an incidentally detected lung nodule can feasibly and independently be implemented across health systems. Use of these methods will likely facilitate the efficient conduct of multi-site studies evaluating practice patterns and associated outcomes.
University of Washington.
Farhood
F
Farjah
Optum360.
Scott
S
Halgrim
Group Health Research Institute.
Diana S M
DS
Buist
Department of Research and Evaluation, Kaiser Permanente Southern California.
Michael K
MK
Gould
Department of Veterans Affairs, VA Puget Sound Health Care System, Health Services Research & Development Center of Innovation.
Steven B
SB
Zeliadt
Seattle Cancer Care Alliance.
Elizabeth T
ET
Loggers
Group Health Research Institute.
David S
DS
Carrell
data collection; lung neoplasms; natural language processing; solitary pulmonary nodule
Br J Cancer. 2008 Jan 29;98(2):270-6
18087271
N Engl J Med. 2013 May 23;368(21):1980-91
23697514
Chest. 2013 May;143(5 Suppl):e93S-e120S
23649456
J Natl Cancer Inst. 2003 Mar 19;95(6):470-8
12644540
Radiology. 2005 Nov;237(2):395-400
16244247
J Natl Compr Canc Netw. 2015 Jan;13(1):23-34; quiz 34
25583767
Chest. 2007 Sep;132(3 Suppl):108S-130S
17873164
Radiology. 2010 Apr;255(1):218-24
20308458
J Am Coll Radiol. 2012 Jul;9(7):468-73
22748786
Am J Respir Crit Care Med. 2012 Feb 15;185(4):363-72
21980032
J Natl Compr Canc Netw. 2012 Oct 1;10(10):1236-71
23054877
J Thorac Oncol. 2012 Aug;7(8):1257-62
22627647
Am J Respir Crit Care Med. 2015 Aug 15;192(4):500-14
26278796
Chest. 2015 Dec;148(6):1405-1414
26087071
Am J Respir Crit Care Med. 2015 Nov 15;192(10):1208-14
26214244
Radiology. 2013 Jan;266(1):304-17
23070270
Ann Intern Med. 2015 Apr 7;162(7):485-91
25664444
J Am Coll Radiol. 2015 Mar;12(3):273-6
25176499
Arch Intern Med. 1997 Apr 28;157(8):849-55
9129544
J Natl Cancer Inst. 2007 May 2;99(9):715-26
17470739
N Engl J Med. 2013 Feb 21;368(8):728-36
23425165
J Am Coll Radiol. 2012 May;9(5):336-9
22554631
N Engl J Med. 2013 Sep 5;369(10):910-9
24004118
Chest. 2003 Jan;123(1 Suppl):89S-96S
12527568
J Chronic Dis. 1987;40(5):373-83
3558716
Chest. 2007 Feb;131(2):383-8
17296637
Thorax. 2008 Apr;63(4):335-41
17965070
JAMA. 2012 Jun 13;307(22):2400-9
22692172
AMIA Annu Symp Proc. 2011;2011:465-9
22195100
J Thorac Imaging. 2011 Feb;26(1):27-31
20622690
JAMA Intern Med. 2014 Jun;174(6):871-80
24710850