Studying Associations Between Heart Failure Self-Management and Rehospitalizations Using Natural Language Processing
Western Journal of Nursing Research: An International Forum for Communicating Nursing Research
Published online on September 14, 2016
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.