Predicting Factors of Re-Hospitalization After Medically Managed Intensive Inpatient Services in Opioid Use Disorder

IntroductionOpioid use disorder has continued to rise in prevalence across the United States, with an estimated 2.5 million Americans ailing from the condition (NIDA, 2020). Medically managed detoxification incurs substantial costs and, when used independently, may not be effective in preventing relapse (Kosten & Baxter, 2019). While numerous studies have focused on predicting the factors of developing opioid use disorder, few have identified predictors of readmission to medically managed withdrawal at an inpatient level of care. Utilizing a high-fidelity dataset from a large multi-site behavioral health hospital, these predictors are explored. MethodsPatients diagnosed with Opioid Use Disorder and hospitalized in the inpatient level of care were analyzed to identify readmission predictors. Factors including patient demographics, patient-reported outcome measures, and post-discharge treatment interventions were included. Patients re-hospitalized to the inpatient level of care were binary labeled in the dataset, and various machine learning algorithms were tested, including machine learning techniques. Methods include random forest, gradient boosting, and deep learning techniques. Evaluation statistics include specificity, accuracy, precision, and Matthew\u27s Coefficient. ResultsOverall, there was a wide variation if correctly predicting the class of patients that would readmit to a medically managed level of inpatient detoxification. Out of the six models evaluated, three of the six did not converge, thus not producing a viable feature ranking. However, of the other three models that did converge, the deep learning model produced almost perfect classification, producing an accuracy of .98. AdaBoost and the logistic regression model produced an accuracy of .97 and .61, respectively. Each of these models produced a similar set of features that were important to predicting which patient profile would readmit to medically managed inpatient detoxification. ConclusionsThe results indicate that overall reduction in the Quick Inventory of Depressive Symptomology, discharge disposition, age, length of stay, and a patient\u27s total number of diagnoses were important features at predicting readmission. Additionally, deep learning algorithms vastly outperformed other machine learning algorithms

Clinical Decision Support at Intermountain Healthcare

book chapterBiomedical Informatic

Utilizing Temporal Information in The EHR for Developing a Novel Continuous Prediction Model

Type 2 diabetes mellitus (T2DM) is a nation-wide prevalent chronic condition, which includes direct and indirect healthcare costs. T2DM, however, is a preventable chronic condition based on previous clinical research. Many prediction models were based on the risk factors identified by clinical trials. One of the major tasks of the T2DM prediction models is to estimate the risks for further testing by HbA1c or fasting plasma glucose to determine whether the patient has or does not have T2DM because nation-wide screening is not cost-effective. Those models had substantial limitations on data quality, such as missing values. In this dissertation, I tested the conventional models which were based on the most widely used risk factors to predict the possibility of developing T2DM. The AUC was an average of 0.5, which implies the conventional model cannot be used to screen for T2DM risks. Based on this result, I further implemented three types of temporal representations, including non-temporal representation, interval-temporal representation, and continuous-temporal representation for building the T2DM prediction model. According to the results, continuous-temporal representation had the best performance. Continuous-temporal representation was based on deep learning methods. The result implied that the deep learning method could overcome the data quality issue and could achieve better performance. This dissertation also contributes to a continuous risk output model based on the seq2seq model. This model can generate a monotonic increasing function for a given patient to predict the future probability of developing T2DM. The model is workable but still has many limitations to overcome. Finally, this dissertation demonstrates some risks factors which are underestimated and are worthy for further research to revise the current T2DM screening guideline. The results were still preliminary. I need to collaborate with an epidemiologist and other fields to verify the findings. In the future, the methods for building a T2DM prediction model can also be used for other prediction models of chronic conditions

Behavior or Diagnosis? Effects of Irritable Patient Behavior and Diagnostic Labels on Mental Illness Stigma

Although research demonstrates significant stigma towards individuals with mental illness, the relative importance of observed behavior and a psychiatric diagnosis in eliciting stigma remains poorly understood. Using video vignettes, three experiments (ns = 195, 749, and 791) examined the effect of irritable (vs. calm) behavior and the presence (vs. absence) of a psychiatric diagnosis (schizophrenia in Studies 1 and 2; schizophrenia and depression in Study 3) on attitudinal, emotional, and behavioral dimensions of stigma towards a fictitious emergency room patient seeking migraine treatment. In line with labeling theory, irritable behavior resulted in greater blameworthy attributions for behavior, greater fear and anger, less caring emotions, and lower perceived warmth. Both a depression and schizophrenia diagnosis elicited stigma by leading to greater endorsements of other stigmatizing attributions (e.g., substance use) as a reason for behavior. Irritable behavior and both psychiatric diagnoses resulted in patients being rated as less predictable and more dangerous, whereas irritable behavior and schizophrenia only resulted in decreased competence. Irritable behavior and psychiatric diagnosis also interacted to predict desire for social distance. When calm, a psychiatric diagnosis predicted greater distance, such that a patient with no label was least stigmatized, one with depression was moderately stigmatized, and one with schizophrenia was most stigmatized. When irritable, the patient elicited a higher desire for distance regardless of psychiatric diagnosis. Mediational analyses show that when controlling for behavior, perceived dangerousness and fear mediate the effect of a diagnosis on desire for distance. In all, results suggest both diagnostic labels and irritable behavior result in stigma via different attitudinal and emotional mechanisms, and that individuals with psychiatric diagnoses face stigma even if behaving calmly. By enriching understanding of the relative importance of irritable behavior and a psychiatric diagnosis on multiple dimensions of mental illness stigma, this work has implications for anti-stigma interventions

Data Science Methods for Nursing-Relevant Patient Outcomes and Clinical Processes The 2019 Literature Year in Review

Data science continues to be recognized and used within healthcare due to the increased availability of large data sets and advanced analytics. It can be challenging for nurse leaders to remain apprised of this rapidly changing landscape. In this article, we describe our findings from a scoping literature review of papers published in 2019 that use data science to explore, explain, and/or predict 15 phenomena of interest to nurses. Fourteen of the 15 phenomena were associated with at least one paper published in 2019. We identified the use of many contemporary data science methods (eg, natural language processing, neural networks) for many of the outcomes. We found many studies exploring Readmissions and Pressure Injuries. The topics of Artificial Intelligence/Machine Learning Acceptance, Burnout, Patient Safety, and Unit Culture were poorly represented. We hope that the studies described in this article help readers: (1) understand the breadth and depth of data science\u27s ability to improve clinical processes and patient outcomes that are relevant to nurses and (2) identify gaps in the literature that are in need of exploratio

Predicting Pancreatic Cancer Using Support Vector Machine

This report presents an approach to predict pancreatic cancer using Support Vector Machine Classification algorithm. The research objective of this project it to predict pancreatic cancer on just genomic, just clinical and combination of genomic and clinical data. We have used real genomic data having 22,763 samples and 154 features per sample. We have also created Synthetic Clinical data having 400 samples and 7 features per sample in order to predict accuracy of just clinical data. To validate the hypothesis, we have combined synthetic clinical data with subset of features from real genomic data. In our results, we observed that prediction accuracy, precision, recall with just genomic data is 80.77%, 20%, 4%. Prediction accuracy, precision, recall with just synthetic clinical data is 93.33%, 95%, 30%. While prediction accuracy, precision, recall for combination of real genomic and synthetic clinical data is 90.83%, 10%, 5%. The combination of real genomic and synthetic clinical data decreased the accuracy since the genomic data is weakly correlated. Thus we conclude that the combination of genomic and clinical data does not improve pancreatic cancer prediction accuracy. A dataset with more significant genomic features might help to predict pancreatic cancer more accurately

DataGauge: A Model-Driven Framework for Systematically Assessing the Quality of Clinical Data for Secondary Use

There is growing interest in the reuse of clinical data for research and clinical healthcare quality improvement. However, direct analysis of clinical data sets can yield misleading results. Data Cleaning is often employed as a means to detect and fix data issues during analysis but this approach lacks of systematicity. Data Quality (DQ) assessments are a more thorough way of spotting threats to the validity of analytical results stemming from data repurposing. This is because DQ assessments aim to evaluate ‘fitness for purpose’. However, there is currently no systematic method to assess DQ for the secondary analysis of clinical data. In this dissertation I present DataGauge, a framework to address this gap in the state of the art. I begin by introducing the problem and its general significance to the field of biomedical and clinical informatics (Chapter 1). I then present a literature review that surveys current methods for the DQ assessment of repurposed clinical data and derive the features required to advance the state of the art (Chapter 2). In chapter 3 I present DataGauge, a model-driven framework for systematically assessing the quality of repurposed clinical data, which addresses current limitations in the state of the art. Chapter 4 describes the development of a guidance framework to ensure the systematicity of DQ assessment design. I then evaluate DataGauge’s ability to flag potential DQ issues in comparison to a systematic state of the art method. DataGauge was able to increase ten fold the number of potential DQ issues found over the systematic state of the art method. It identified more specific issues that were a direct threat to fitness for purpose, but also provided broader coverage of the clinical data types and knowledge domains involved in secondary analyses. DataGauge sets the groundwork for systematic and purpose-specific DQ assessments that fully integrate with secondary analysis workflows. It also promotes a team-based approach and the explicit definition of DQ requirements to support communication and transparent reporting of DQ results. Overall, this work provides tools that pave the way to a deeper understanding of repurposed clinical dataset limitations before analysis. It is also a first step towards the automation of purpose-specific DQ assessments for the secondary use of clinical data. Future work will consist of further development of these methods and validating them with research teams making secondary use of clinical data

The emerging landscape of health research based on biobanks linked to electronic health records: Existing resources, statistical challenges, and potential opportunities

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154448/1/sim8445_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154448/2/sim8445.pd

An Interoperable Clinical Cardiology Electronic Health Record System - a standards based approach for Clinical Practice and Research with Data Reuse

Currently in hospitals, several information systems manage, very often autonomously, the patient’s personal, clinical and diagnostic data. This originates a clinical information management system consisting of a myriad of independent subsystems which, although efficient in their specific purpose, make the integration of the whole system very difficult and limit the use of clinical data, especially as regards the reuse of these data for research purposes. Mainly for these reasons, the management of the Genoese ASL3 decided to commission the University of Genoa to set up a medical record system that could be easily integrated with the rest of the information system already present, but which offered solid interoperability features, and which could support the research skills of hospital health workers. My PhD work aimed to develop an electronic health record system for a cardiology ward, obtaining a prototype which is functional and usable in a hospital ward. The choice of cardiology was due to the wide availability of the staff of the cardiology department to support me in the development and in the test phase. The resulting medical record system has been designed “ab initio” to be fully integrated into the hospital information system and to exchange data with the regional health information infrastructure. In order to achieve interoperability the system is based on the Health Level Seven standards for exchanging information between medical information systems. These standards are widely deployed and allow for the exchange of information in several functional domains. Specific decision support sections for particular aspects of the clinical life were also included. The data collected by this system were the basis for examples of secondary use for the development of two models based on machine learning algorithms. The first model allows to predict mortality in patients with heart failure within 6 months from their admission, and the second is focused on the discrimination between heart failure versus chronic ischemic heart disease in the elderly population, which is the widest population section served by the cardiological ward