Automated rating of patient and physician emotion in primary care visits

OBJECTIVE: Train machine learning models that automatically predict emotional valence of patient and physician in primary care visits. METHODS: Using transcripts from 353 primary care office visits with 350 patients and 84 physicians (Cook, 2002 [1], Tai-Seale et al., 2015 [2]), we developed two machine learning models (a recurrent neural network with a hierarchical structure and a logistic regression classifier) to recognize the emotional valence (positive, negative, neutral) (Posner et al., 2005 [3]) of each utterance. We examined the agreement of human-generated ratings of emotional valence with machine learning model ratings of emotion. RESULTS: The agreement of emotion ratings from the recurrent neural network model with human ratings was comparable to that of human-human inter-rater agreement. The weighted-average of the correlation coefficients for the recurrent neural network model with human raters was 0.60, and the human rater agreement was also 0.60. CONCLUSIONS: The recurrent neural network model predicted the emotional valence of patients and physicians in primary care visits with similar reliability as human raters. PRACTICE IMPLICATIONS: As the first machine learning-based evaluation of emotion recognition in primary care visit conversations, our work provides valuable baselines for future applications that might help monitor patient emotional signals, supporting physicians in empathic communication, or examining the role of emotion in patient-centered care

Randomised Trial to Evaluate the Effectiveness and Impact of Offering Postvisit Decision Support and Assistance in Obtaining Physician-Recommended Colorectal Cancer Screening: The e-Assist: Colon Health Study - A Protocol Study

INTRODUCTION: How to provide practice-integrated decision support to patients remains a challenge. We are testing the effectiveness of a practice-integrated programme targeting patients with a physician recommendation for colorectal cancer (CRC) screening. METHODS AND ANALYSIS: In partnership with healthcare teams, we developed \u27e-assist: Colon Health\u27, a patient-targeted, postvisit CRC screening decision support programme. The programme is housed within an electronic health record (EHR)-embedded patient portal. It leverages a physician screening recommendation as the cue to action and uses the portal to enrol and intervene with patients. Programme content complements patient-physician discussions by encouraging screening, addressing common questions and assisting with barrier removal. For evaluation, we are using a randomised trial in which patients are randomised to receive e-assist: Colon Health or one of two controls (usual care plus or usual care). Trial participants are average-risk, aged 50-75 years, due for CRC screening and received a physician order for stool testing or colonoscopy. Effectiveness will be evaluated by comparing screening use, as documented in the EHR, between trial enrollees in the e-assist: Colon Health and usual care plus (CRC screening information receipt) groups. Secondary outcomes include patient-perceived benefits of, barriers to and support for CRC screening and patient-reported CRC screening intent. The usual care group will be used to estimate screening use without intervention and programme impact at the population level. Differences in outcomes by study arm will be estimated with hierarchical logit models where patients are nested within physicians. ETHICS AND DISSEMINATION: All trial aspects have been approved by the Institutional Review Board of the health system in which the trial is being conducted. We will disseminate findings in diverse scientific venues and will target clinical and quality improvement audiences via other venues. The intervention could serve as a model for filling the gap between physician recommendations and patient action. TRIAL REGISTRATION NUMBER: NCT02798224; Pre-results

A targeted decision aid for the elderly to decide whether to undergo colorectal cancer screening: development and results of an uncontrolled trial

Abstract: Background: Competing causes of mortality in the elderly decrease the potential net benefit from colorectal cancer screening and increase the likelihood of potential harms. Individualized decision making has been recommended, so that the elderly can decide whether or not to undergo colorectal cancer (CRC) screening. The objective is to develop and test a decision aid designed to promote individualized colorectal cancer screening decision making for adults age 75 and over. Methods: We used formative research and cognitive testing to develop and refine the decision aid. We then tested the decision aid in an uncontrolled trial. The primary outcome was the proportion of patients who were prepared to make an individualized decision, defined a priori as having adequate knowledge (10/15 questions correct) and clear values (25 or less on values clarity subscale of decisional conflict scale). Secondary outcomes included overall score on the decisional conflict scale, and preferences for undergoing screening. Results: We enrolled 46 adults in the trial. The decision aid increased the proportion of participants with adequate knowledge from 4% to 52% (p < 0.01) and the proportion prepared to make an individualized decision from 4% to 41% (p < 0.01). The proportion that preferred to undergo CRC screening decreased from 67% to 61% (p = 0. 76); 7 participants (15%) changed screening preference (5 against screening, 2 in favor of screening) Conclusion: In an uncontrolled trial, the elderly participants appeared better prepared to make an individualized decision about whether or not to undergo CRC screening after using the decision aid

Point-of-Care Testing in Oral Anticoagulant Monitoring: Implications for Patient Management

Capillary whole blood point-of-care instruments for prothrombin time testing have been available for the last 10 years for use both in an office or hospital setting as well as at home by patients for self-monitoring of oral anticoagulant therapy. There are currently 4 types of instruments available, all of which initiate coagulation with thromboplastin, but the end-point determination of coagulation differs in the various instruments. The accuracy and precision of these instruments have been validated in a number of studies and their suitability for monitoring oral anticoagulation therapy has been established. A number of small pilot trials have assessed their value for patient self-testing at home and have produced preliminary evidence that such monitoring may produce better results than achieved with monitoring performed in the usual fashion. A number of studies have also shown that suitably educated patients can also manage their own dosage adjustments based on their own testing at home. Furthermore, preliminary studies also suggest that such monitoring is a cost-effective means of managing oral anticoagulation.Reviews-on-treatment, Coagulation-monitoring, Patient-education, Warfarin, Clinical-pharmacokinetics, Pharmacoeconomics, Self-medication, Anticoagulants, Economic-implications

Logic model framework for considering the inputs, processes and outcomes of a healthcare organisation-research partnership

BACKGROUND: The published literature provides few insights regarding how to develop or consider the effects of knowledge co-production partnerships in the context of delivery system science. OBJECTIVE: To describe how a healthcare organisation-university-based research partnership was developed and used to design, develop and implement a practice-integrated decision support tool for patients with a physician recommendation for colorectal cancer screening. DESIGN: Instrumental case study. PARTICIPANTS: Data were ascertained from project documentation records and semistructured questionnaires sent to 16 healthcare organisation leaders and staff, research investigators and research staff members. RESULTS: Using a logic model framework, we organised the key inputs, processes and outcomes of a healthcare organisation-university-based research partnership. In addition to pragmatic researchers, partnership inputs included a healthcare organisation with a supportive practice environment and an executive-level project sponsor, a mid-level manager to serve as the organisational champion and continual access to organisational employees with relevant technical, policy and system/process knowledge. During programme design and implementation, partnership processes included using project team meetings, standing organisational meetings and one-on-one consultancies to provide platforms for shared learning and problem solving. Decision-making responsibility was shared between the healthcare organisation and research team. We discuss the short-term outcomes of the partnership, including how the partnership affected the current research team\u27s knowledge and health system initiatives. CONCLUSION: Using a logic model framework, we have described how a healthcare organisation-university-based research team partnership was developed. Others interested in developing, implementing and evaluating knowledge co-production partnerships in the context of delivery system science projects can use the experiences to consider ways to develop, implement and evaluate similar co-production partnerships

Physician use of persuasion and colorectal cancer screening

The impact of patient-physician communication on subsequent patient behavior has rarely been evaluated in the context of colorectal cancer (CRC) screening discussions. We describe physicians\u27 use of persuasive techniques when recommending CRC screening and evaluate its association with patients\u27 subsequent adherence to screening. Audio recordings of N = 414 periodic health examinations were joined with screening use data from electronic medical records and pre-/post-visit patient surveys. The association between persuasion and screening was assessed using generalized estimating equations. According to observer ratings, primary care physicians frequently use persuasive techniques (63 %) when recommending CRC screening, most commonly argument or refutation. However, physician persuasion was not associated with subsequent screening adherence. Physician use of persuasion may be a common vehicle for information provision during CRC screening discussions; however, our results do not support the sole reliance on persuasive techniques if the goal is to improve adherence to recommended screening

Baseline laboratory monitoring of cardiovascular medications in elderly health maintenance organization enrollees.

OBJECTIVES: To identify correlates of laboratory monitoring errors in elderly health maintenance organization (HMO) members at the initiation of therapy with cardiovascular medications. DESIGN: Cross-sectional study in 10 HMOs. SETTING: United States. PARTICIPANTS: From a 2 million-member sample, individuals aged 65 and older who received one of seven cardiovascular medications (angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), amiodarone, digoxin, diuretics, potassium supplements, and statins) and did not have recommended baseline monitoring performed during the 180 days before or 14 days after the index dispensing. MEASUREMENTS: The proportion of members receiving each drug for whom recommended laboratory monitoring was not performed. Laboratory monitoring error rates stratified by sex, age group, chronic disease score, and HMO site were examined, and logistic regression was used to identify predictors of laboratory monitoring errors. RESULTS: Error rates varied by medication class, ranging from 23% of patients receiving potassium supplementation without serum potassium and serum creatinine monitoring to 58% of patients receiving amiodarone who did not have recommended monitoring for thyroid and liver function. Highest error rates occurred in the youngest elderly for ACE inhibitors, ARBs, digoxin, diuretics, and potassium supplements, although in patients receiving amiodarone and statins, errors were most frequent in the oldest elderly. Errors occurred more frequently in patients with less comorbidity. CONCLUSION: Laboratory monitoring errors occurred frequently in elderly HMO members at the initiation of therapy with cardiovascular medications. Further study must examine the association between these errors and adverse outcomes

C-A3-01: The Effect of an Automated Reminder Call Intervention on Completion of Fecal Occult Blood Testing (FOBT)

Background: Colorectal cancer (CRC) is the third most common cancer in the United States and is associated with significant morbidity and mortality. Although CRC has a good prognosis if diagnosed early, screening rates remain low. Innovative, low cost intervention, such as the use of automated reminder calls, may increase CRC screening rates. The objective of this prospective study was to determine the effect of an automated telephone reminder message on completion of a fecal occult blood test (FOBT), an evidence-based screening method for populations with average risk for CRC