16,208 research outputs found
Using structured and unstructured data to identify patients’ need for services that address the social determinants of health
Introduction
Increasingly, health care providers are adopting population health management approaches that address the social determinants of health (SDH). However, effectively identifying patients needing services that address a SDH in primary care settings is challenging. The purpose of the current study is to explore how various data sources can identify adult primary care patients that are in need of services that address SDH.
Methods
A cross-sectional study described patients in need of SDH services offered by a safety-net hospital’s federally qualified health center clinics. SDH services of social work, behavioral health, nutrition counseling, respiratory therapy, financial planning, medical-legal partnership assistance, patient navigation, and pharmacist consultation were offered on a co-located basis and were identified using structured billing and scheduling data, and unstructured electronic health record data. We report the prevalence of the eight different SDH service needs and the patient characteristics associated with service need. Moreover, characteristics of patients with SDH services need documented in structured data sources were compared with those documented by unstructured data sources.
Results
More than half (53%) of patients needed SDH services. Those in need of such services tended to be female, older, more medically complex, and higher utilizers of services. Structured and unstructured data sources exhibited poor agreement on patient SDH services need. Patients with SDH services need documented by unstructured data tended to be more complex.
Discussion
The need for SDH services among a safety-net population is high. Identifying patients in need of such services requires multiple data sources with structured and unstructured data
A global framework for action to improve the primary care response to chronic non-communicable diseases: a solution to a neglected problem.
BACKGROUND: Although in developing countries the burden of morbidity and mortality due to infectious diseases has often overshadowed that due to chronic non-communicable diseases (NCDs), there is evidence now of a shift of attention to NCDs. DISCUSSION: Decreasing the chronic NCD burden requires a two-pronged approach: implementation of the multisectoral policies aimed at decreasing population-level risks for NCDs, and effective and affordable delivery of primary care interventions for patients with chronic NCDs. The primary care response to common NCDs is often unstructured and inadequate. We therefore propose a programmatic, standardized approach to the delivery of primary care interventions for patients with NCDs, with a focus on hypertension, diabetes mellitus, chronic airflow obstruction, and obesity. The benefits of this approach will extend to patients with related conditions, e.g. those with chronic kidney disease caused by hypertension or diabetes. This framework for a "public health approach" is informed by experience of scaling up interventions for chronic infectious diseases (tuberculosis and HIV). The lessons learned from progress in rolling out these interventions include the importance of gaining political commitment, developing a robust strategy, delivering standardised interventions, and ensuring rigorous monitoring and evaluation of progress towards defined targets. The goal of the framework is to reduce the burden of morbidity, disability and premature mortality related to NCDs through a primary care strategy which has three elements: 1) identify and address modifiable risk factors, 2) screen for common NCDs and 3) and diagnose, treat and follow-up patients with common NCDs using standard protocols. The proposed framework for NCDs borrows the same elements as those developed for tuberculosis control, comprising a goal, strategy and targets for NCD control, a package of interventions for quality care, key operations for national implementation of these interventions (political commitment, case-finding among people attending primary care services, standardised diagnostic and treatment protocols, regular drug supply, and systematic monitoring and evaluation), and indicators to measure progress towards increasing the impact of primary care interventions on chronic NCDs. The framework needs evaluation, then adaptation in different settings. SUMMARY: A framework for a programmatic "public health approach" has the potential to improve on the current unstructured approach to primary care of people with chronic NCDs. Research to establish the cost, value and feasibility of implementing the framework will pave the way for international support to extend the benefit of this approach to the millions of people worldwide with chronic NCDs
Application of Natural Language Processing to Determine User Satisfaction in Public Services
Research on customer satisfaction has increased substantially in recent
years. However, the relative importance and relationships between different
determinants of satisfaction remains uncertain. Moreover, quantitative studies
to date tend to test for significance of pre-determined factors thought to have
an influence with no scalable means to identify other causes of user
satisfaction. The gaps in knowledge make it difficult to use available
knowledge on user preference for public service improvement. Meanwhile, digital
technology development has enabled new methods to collect user feedback, for
example through online forums where users can comment freely on their
experience. New tools are needed to analyze large volumes of such feedback. Use
of topic models is proposed as a feasible solution to aggregate open-ended user
opinions that can be easily deployed in the public sector. Generated insights
can contribute to a more inclusive decision-making process in public service
provision. This novel methodological approach is applied to a case of service
reviews of publicly-funded primary care practices in England. Findings from the
analysis of 145,000 reviews covering almost 7,700 primary care centers indicate
that the quality of interactions with staff and bureaucratic exigencies are the
key issues driving user satisfaction across England
Natural Language Processing – Finding the Missing Link for Oncologic Data, 2022
Oncology like most medical specialties, is undergoing a data revolution at the center of which lie vast and growing amounts of clinical data in unstructured, semi-structured and structed formats. Artificial intelligence approaches are widely employed in research endeavors in an attempt to harness electronic medical records data to advance patient outcomes. The use of clinical oncologic data, although collected on large scale, particularly with the increased implementation of electronic medical records, remains limited due to missing, incorrect or manually entered data in registries and the lack of resource allocation to data curation in real world settings. Natural Language Processing (NLP) may provide an avenue to extract data from electronic medical records and as a result has grown considerably in medicine to be employed for documentation, outcome analysis, phenotyping and clinical trial eligibility. Barriers to NLP persist with inability to aggregate findings across studies due to use of different methods and significant heterogeneity at all levels with important parameters such as patient comorbidities and performance status lacking implementation in AI approaches. The goal of this review is to provide an updated overview of natural language processing (NLP) and the current state of its application in oncology for clinicians and researchers that wish to implement NLP to augment registries and/or advance research projects
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Artificial intelligence approaches to predicting and detecting cognitive decline in older adults: A conceptual review.
Preserving cognition and mental capacity is critical to aging with autonomy. Early detection of pathological cognitive decline facilitates the greatest impact of restorative or preventative treatments. Artificial Intelligence (AI) in healthcare is the use of computational algorithms that mimic human cognitive functions to analyze complex medical data. AI technologies like machine learning (ML) support the integration of biological, psychological, and social factors when approaching diagnosis, prognosis, and treatment of disease. This paper serves to acquaint clinicians and other stakeholders with the use, benefits, and limitations of AI for predicting, diagnosing, and classifying mild and major neurocognitive impairments, by providing a conceptual overview of this topic with emphasis on the features explored and AI techniques employed. We present studies that fell into six categories of features used for these purposes: (1) sociodemographics; (2) clinical and psychometric assessments; (3) neuroimaging and neurophysiology; (4) electronic health records and claims; (5) novel assessments (e.g., sensors for digital data); and (6) genomics/other omics. For each category we provide examples of AI approaches, including supervised and unsupervised ML, deep learning, and natural language processing. AI technology, still nascent in healthcare, has great potential to transform the way we diagnose and treat patients with neurocognitive disorders
Social and behavioral determinants of health in the era of artificial intelligence with electronic health records: A scoping review
Background: There is growing evidence that social and behavioral determinants
of health (SBDH) play a substantial effect in a wide range of health outcomes.
Electronic health records (EHRs) have been widely employed to conduct
observational studies in the age of artificial intelligence (AI). However,
there has been little research into how to make the most of SBDH information
from EHRs. Methods: A systematic search was conducted in six databases to find
relevant peer-reviewed publications that had recently been published. Relevance
was determined by screening and evaluating the articles. Based on selected
relevant studies, a methodological analysis of AI algorithms leveraging SBDH
information in EHR data was provided. Results: Our synthesis was driven by an
analysis of SBDH categories, the relationship between SBDH and
healthcare-related statuses, and several NLP approaches for extracting SDOH
from clinical literature. Discussion: The associations between SBDH and health
outcomes are complicated and diverse; several pathways may be involved. Using
Natural Language Processing (NLP) technology to support the extraction of SBDH
and other clinical ideas simplifies the identification and extraction of
essential concepts from clinical data, efficiently unlocks unstructured data,
and aids in the resolution of unstructured data-related issues. Conclusion:
Despite known associations between SBDH and disease, SBDH factors are rarely
investigated as interventions to improve patient outcomes. Gaining knowledge
about SBDH and how SBDH data can be collected from EHRs using NLP approaches
and predictive models improves the chances of influencing health policy change
for patient wellness, and ultimately promoting health and health equity.
Keywords: Social and Behavioral Determinants of Health, Artificial
Intelligence, Electronic Health Records, Natural Language Processing,
Predictive ModelComment: 32 pages, 5 figure
TB STIGMA – MEASUREMENT GUIDANCE
TB is the most deadly infectious disease in the world, and stigma continues to play a significant role in worsening the epidemic. Stigma and discrimination not only stop people from seeking care but also make it more difficult for those on treatment to continue, both of which make the disease more difficult to treat in the long-term and mean those infected are more likely to transmit the disease to those around them. TB Stigma – Measurement Guidance is a manual to help generate enough information about stigma issues to design and monitor and evaluate efforts to reduce TB stigma. It can help in planning TB stigma baseline measurements and monitoring trends to capture the outcomes of TB stigma reduction efforts. This manual is designed for health workers, professional or management staff, people who advocate for those with TB, and all who need to understand and respond to TB stigma
An Exploratory Study of Patient Falls
Debate continues between the contribution of education level and clinical expertise in the nursing practice environment. Research suggests a link between Baccalaureate of Science in Nursing (BSN) nurses and positive patient outcomes such as lower mortality, decreased falls, and fewer medication errors. Purpose: To examine if there a negative correlation between patient falls and the level of nurse education at an urban hospital located in Midwest Illinois during the years 2010-2014? Methods: A retrospective crosssectional cohort analysis was conducted using data from the National Database of Nursing Quality Indicators (NDNQI) from the years 2010-2014. Sample: Inpatients aged ≥ 18 years who experienced a unintentional sudden descent, with or without injury that resulted in the patient striking the floor or object and occurred on inpatient nursing units. Results: The regression model was constructed with annual patient falls as the dependent variable and formal education and a log transformed variable for percentage of certified nurses as the independent variables. The model overall is a good fit, F (2,22) = 9.014, p = .001, adj. R2 = .40. Conclusion: Annual patient falls will decrease by increasing the number of nurses with baccalaureate degrees and/or certifications from a professional nursing board-governing body
Social media as a data gathering tool for international business qualitative research: opportunities and challenges
Lusophone African (LA) multinational enterprises (MNEs) are becoming a significant pan-African and global economic force regarding their international presence and influence. However, given the extreme poverty and lack of development in their home markets, many LA enterprises seeking to internationalize lack resources and legitimacy in international markets. Compared to higher income emerging markets, Lusophone enterprises in Africa face more significant challenges in their internationalization efforts. Concomitantly, conducting significant international business (IB) research in these markets to understand these MNEs internationalization strategies can be a very daunting task. The fast-growing rise of social media on the Internet, however, provides an opportunity for IB researchers to examine new phenomena in these markets in innovative ways. Unfortunately, for various reasons, qualitative researchers in IB have not fully embraced this opportunity. This article studies the use of social media in qualitative research in the field of IB. It offers an illustrative case based on qualitative research on internationalization modes of LAMNEs conducted by the authors in Angola and Mozambique using social media to identify and qualify the population sample, as well as interact with subjects and collect data. It discusses some of the challenges of using social media in those regions of Africa and suggests how scholars can design their studies to capitalize on social media and corresponding data as a tool for qualitative research. This article underscores the potential opportunities and challenges inherent in the use of social media in IB-oriented qualitative research, providing recommendations on how qualitative IB researchers can design their studies to capitalize on data generated by social media.https://doi.org/10.1080/15475778.2019.1634406https://doi.org/10.1080/15475778.2019.1634406https://doi.org/10.1080/15475778.2019.1634406https://doi.org/10.1080/15475778.2019.1634406Accepted manuscriptPublished versio
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