scholarly journals Use of electronic medical records in development and validation of risk prediction models of hospital readmission: systematic review

BMJ ◽  
2020 ◽  
pp. m958 ◽  
Author(s):  
Elham Mahmoudi ◽  
Neil Kamdar ◽  
Noa Kim ◽  
Gabriella Gonzales ◽  
Karandeep Singh ◽  
...  
Keyword(s):  
Machine Learning ◽  
Systematic Review ◽  
Language Processing ◽  
Predictive Models ◽  
Hospital Readmission ◽  
Prediction Models ◽  
Cox Regression ◽  
Patient Specific ◽  
Day Hospital ◽  
Significant Difference

Abstract Objective To provide focused evaluation of predictive modeling of electronic medical record (EMR) data to predict 30 day hospital readmission. Design Systematic review. Data source Ovid Medline, Ovid Embase, CINAHL, Web of Science, and Scopus from January 2015 to January 2019. Eligibility criteria for selecting studies All studies of predictive models for 28 day or 30 day hospital readmission that used EMR data. Outcome measures Characteristics of included studies, methods of prediction, predictive features, and performance of predictive models. Results Of 4442 citations reviewed, 41 studies met the inclusion criteria. Seventeen models predicted risk of readmission for all patients and 24 developed predictions for patient specific populations, with 13 of those being developed for patients with heart conditions. Except for two studies from the UK and Israel, all were from the US. The total sample size for each model ranged between 349 and 1 195 640. Twenty five models used a split sample validation technique. Seventeen of 41 studies reported C statistics of 0.75 or greater. Fifteen models used calibration techniques to further refine the model. Using EMR data enabled final predictive models to use a wide variety of clinical measures such as laboratory results and vital signs; however, use of socioeconomic features or functional status was rare. Using natural language processing, three models were able to extract relevant psychosocial features, which substantially improved their predictions. Twenty six studies used logistic or Cox regression models, and the rest used machine learning methods. No statistically significant difference (difference 0.03, 95% confidence interval −0.0 to 0.07) was found between average C statistics of models developed using regression methods (0.71, 0.68 to 0.73) and machine learning (0.74, 0.71 to 0.77). Conclusions On average, prediction models using EMR data have better predictive performance than those using administrative data. However, this improvement remains modest. Most of the studies examined lacked inclusion of socioeconomic features, failed to calibrate the models, neglected to conduct rigorous diagnostic testing, and did not discuss clinical impact.

scholarly journals Predicting all-cause 90-day hospital readmission for dental patients using machine learning methods

BDJ Open ◽  
2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Wei Li ◽  
Martin S. Lipsky ◽  
Eric S. Hon ◽  
Weicong Su ◽  
Sharon Su ◽  
...  
Keyword(s):  
Machine Learning ◽  
Hospital Readmission ◽  
Health Care Quality ◽  
Prediction Models ◽  
Characteristic Curve ◽  
Model Performance ◽  
Care Quality ◽  
Support Vector ◽  
Day Hospital ◽  
Dental Patients

Abstract Introduction Hospital readmission rates are an indicator of the health care quality provided by hospitals. Applying machine learning (ML) to a hospital readmission database offers the potential to identify patients at the highest risk for readmission. However, few studies applied ML methods to predict hospital readmission. This study sought to assess ML as a tool to develop prediction models for all-cause 90-day hospital readmission for dental patients. Methods Using the 2013 Nationwide Readmissions Database (NRD), the study identified 9260 cases for all-cause 90-day index admission for dental patients. Five ML classification algorithms including decision tree, logistic regression, support vector machine, k-nearest neighbors, and artificial neural network (ANN) were implemented to build predictive models. The model performance was estimated and compared by using area under the receiver operating characteristic curve (AUC), and accuracy, sensitivity, specificity, and precision. Results Hospital readmission within 90 days occurred in 1746 cases (18.9%). Total charges, number of diagnosis, age, number of chronic conditions, length of hospital stays, number of procedures, primary expected payer, and severity of illness emerged as the top eight important features in all-cause 90-day hospital readmission. All models had similar performance with ANN (AUC = 0.743) slightly outperforming the rest. Conclusion This study demonstrates a potential annual saving of over $500 million if all of the 90-day readmission cases could be prevented for 21 states represented in the NRD. Among the methods used, the prediction model built by ANN exhibited the best performance. Further testing using ANN and other methods can help to assess important readmission risk factors and to target interventions to those at the greatest risk.

Machine learning for prospective identification of immunotherapy related adverse events (irAEs).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14064-e14064
Author(s):  
Daniel Margalski ◽  
Thomas Lycan ◽  
Suraj Rajendran ◽  
Umit Topaloglu
Keyword(s):  
Machine Learning ◽  
Adverse Events ◽  
Language Processing ◽  
Prediction Models ◽  
Learning Algorithm ◽  
Class Imbalance ◽  
Word Embedding ◽  
Progress Notes ◽  
Starting Point ◽  
Significant Difference

e14064 Background: The ubiquitous implementation of immunotherapy has significantly improved outcomes in the treatment of cancer patients; however, once rare adverse events from these therapies have increased in lock step. We now face an increased burden of identification on providers with limited experience in the diagnosis of irAEs. We use machine learning to develop prediction models that will aid providers in identifying patients at high risk for developing irAEs as well as for multiple downstream applications. Methods: We have manually extracted progress notes from 462 patients with non-small cell lung cancer treated with immunotherapy who had known irAEÕs, with focus on pneumonitis, colitis, and rash; the most common symptomatic irAEÕs. Labels were applied by clinician review to train the machine learning algorithm to identify the predictive signals at the earliest stage of recognition possible. As a standard Natural Language Processing method, we cleaned the notes to standardize punctuation, numbers and special characters. Next, we created a word embedding matrix utilizing word2vec as well as Google News Vector. Finally, we implemented a Convolutional Neural Network (CNN) on the Microsoft Azure Databricks platform. Due to class imbalance, we deployed a Synthetic Minority Over-sampling Technique algorithm as a correction. We prioritized F1 score in the analysis given the heterogeneity of the data, but will present accuracy, precision and recall as well. Results: We trained our CNN with 10 epochs resulting in an F1 of 0.428, accuracy of 0.895, precision of 0.75 and recall of 0.3. There was no significant difference in results between the word embedding matrices. Conclusions: Using machine learning, we created an algorithm for irAE prediction that was accurate but lacked recall. This will serve as the foundation of implementations including the creation of a clinical decision support tool to guide focused and appropriate treatment of the unique toxicity of irAEs. Although informative as a starting point, this model had a final F1 score that was lower than expected presumably due to class imbalance of input data and the temporal nature of progress notes, which limits the utility of a CNN. Future iterations of the algorithm will include supplementary documentation and implement recurrent neural networks with long short-term memory architecture to address these limitations.

scholarly journals Machine Learning in Medical Emergencies: a Systematic Review and Analysis

2021 ◽  
Vol 45 (10) ◽  
Author(s):  
Inés Robles Mendo ◽  
Gonçalo Marques ◽  
Isabel de la Torre Díez ◽  
Miguel López-Coronado ◽  
Francisco Martín-Rodríguez
Keyword(s):  
Machine Learning ◽  
Systematic Review ◽  
Language Processing ◽  
Emergency Services ◽  
Clinical Decision ◽  
Quality Of Healthcare ◽  
The Other ◽  
Other Hand ◽  
Increasing Demand ◽  
Commercial Applications

AbstractDespite the increasing demand for artificial intelligence research in medicine, the functionalities of his methods in health emergency remain unclear. Therefore, the authors have conducted this systematic review and a global overview study which aims to identify, analyse, and evaluate the research available on different platforms, and its implementations in healthcare emergencies. The methodology applied for the identification and selection of the scientific studies and the different applications consist of two methods. On the one hand, the PRISMA methodology was carried out in Google Scholar, IEEE Xplore, PubMed ScienceDirect, and Scopus. On the other hand, a review of commercial applications found in the best-known commercial platforms (Android and iOS). A total of 20 studies were included in this review. Most of the included studies were of clinical decisions (n = 4, 20%) or medical services or emergency services (n = 4, 20%). Only 2 were focused on m-health (n = 2, 10%). On the other hand, 12 apps were chosen for full testing on different devices. These apps dealt with pre-hospital medical care (n = 3, 25%) or clinical decision support (n = 3, 25%). In total, half of these apps are based on machine learning based on natural language processing. Machine learning is increasingly applicable to healthcare and offers solutions to improve the efficiency and quality of healthcare. With the emergence of mobile health devices and applications that can use data and assess a patient's real-time health, machine learning is a growing trend in the healthcare industry.

scholarly journals Applying natural language processing and machine learning techniques to patient experience feedback: a systematic review

2021 ◽  
Vol 28 (1) ◽  
pp. e100262
Author(s):  
Mustafa Khanbhai ◽  
Patrick Anyadi ◽  
Joshua Symons ◽  
Kelsey Flott ◽  
Ara Darzi ◽  
...  
Keyword(s):  
Machine Learning ◽  
Systematic Review ◽  
Social Media ◽  
Natural Language Processing ◽  
Natural Language ◽  
Patient Experience ◽  
Language Processing ◽  
Performance Metrics ◽  
Free Text ◽  
Patient Feedback

ObjectivesUnstructured free-text patient feedback contains rich information, and analysing these data manually would require a lot of personnel resources which are not available in most healthcare organisations.To undertake a systematic review of the literature on the use of natural language processing (NLP) and machine learning (ML) to process and analyse free-text patient experience data.MethodsDatabases were systematically searched to identify articles published between January 2000 and December 2019 examining NLP to analyse free-text patient feedback. Due to the heterogeneous nature of the studies, a narrative synthesis was deemed most appropriate. Data related to the study purpose, corpus, methodology, performance metrics and indicators of quality were recorded.ResultsNineteen articles were included. The majority (80%) of studies applied language analysis techniques on patient feedback from social media sites (unsolicited) followed by structured surveys (solicited). Supervised learning was frequently used (n=9), followed by unsupervised (n=6) and semisupervised (n=3). Comments extracted from social media were analysed using an unsupervised approach, and free-text comments held within structured surveys were analysed using a supervised approach. Reported performance metrics included the precision, recall and F-measure, with support vector machine and Naïve Bayes being the best performing ML classifiers.ConclusionNLP and ML have emerged as an important tool for processing unstructured free text. Both supervised and unsupervised approaches have their role depending on the data source. With the advancement of data analysis tools, these techniques may be useful to healthcare organisations to generate insight from the volumes of unstructured free-text data.

scholarly journals Prediction Models for Public Health Containment Measures on COVID-19 Using Artificial Intelligence and Machine Learning: A Systematic Review

2021 ◽  
Vol 18 (9) ◽  
pp. 4499
Author(s):  
Anil Babu Payedimarri ◽  
Diego Concina ◽  
Luigi Portinale ◽  
Massimo Canonico ◽  
Deborah Seys ◽  
...  
Keyword(s):  
Public Health ◽  
Artificial Intelligence ◽  
Machine Learning ◽  
Systematic Review ◽  
Public Transportation ◽  
Prediction Models ◽  
Positive Impact ◽  
Health Interventions ◽  
Public Health Interventions ◽  
Commercial Activities

Artificial Intelligence (AI) and Machine Learning (ML) have expanded their utilization in different fields of medicine. During the SARS-CoV-2 outbreak, AI and ML were also applied for the evaluation and/or implementation of public health interventions aimed to flatten the epidemiological curve. This systematic review aims to evaluate the effectiveness of the use of AI and ML when applied to public health interventions to contain the spread of SARS-CoV-2. Our findings showed that quarantine should be the best strategy for containing COVID-19. Nationwide lockdown also showed positive impact, whereas social distancing should be considered to be effective only in combination with other interventions including the closure of schools and commercial activities and the limitation of public transportation. Our findings also showed that all the interventions should be initiated early in the pandemic and continued for a sustained period. Despite the study limitation, we concluded that AI and ML could be of help for policy makers to define the strategies for containing the COVID-19 pandemic.

Machine Learning-based Prediction Models for Diagnosis and Prognosis in Inflammatory Bowel Diseases: A Systematic Review

2021 ◽  
Author(s):  
Nghia H Nguyen ◽  
Dominic Picetti ◽  
Parambir S Dulai ◽  
Vipul Jairath ◽  
William J Sandborn ◽  
...  
Keyword(s):  
Machine Learning ◽  
Systematic Review ◽  
Risk Prediction ◽  
Statistical Models ◽  
Prediction Models ◽  
Risk Of Bias ◽  
Learning Models ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Machine Learning Models

Abstract Background and Aims There is increasing interest in machine learning-based prediction models in inflammatory bowel diseases (IBD). We synthesized and critically appraised studies comparing machine learning vs. traditional statistical models, using routinely available clinical data for risk prediction in IBD. Methods Through a systematic review till January 1, 2021, we identified cohort studies that derived and/or validated machine learning models, based on routinely collected clinical data in patients with IBD, to predict the risk of harboring or developing adverse clinical outcomes, and reported its predictive performance against a traditional statistical model for the same outcome. We appraised the risk of bias in these studies using the Prediction model Risk of Bias ASsessment (PROBAST) tool. Results We included 13 studies on machine learning-based prediction models in IBD encompassing themes of predicting treatment response to biologics and thiopurines, predicting longitudinal disease activity and complications and outcomes in patients with acute severe ulcerative colitis. The most common machine learnings models used were tree-based algorithms, which are classification approaches achieved through supervised learning. Machine learning models outperformed traditional statistical models in risk prediction. However, most models were at high risk of bias, and only one was externally validated. Conclusions Machine learning-based prediction models based on routinely collected data generally perform better than traditional statistical models in risk prediction in IBD, though frequently have high risk of bias. Future studies examining these approaches are warranted, with special focus on external validation and clinical applicability.

scholarly journals Covid19Risk.ai: An open source repository and online calculator of prediction models for early diagnosis and prognosis of Covid-19

2021 ◽  
Author(s):  
Iva Halilaj ◽  
Avishek Chatterjee ◽  
Yvonka van Wijk ◽  
Guangyao Wu ◽  
Brice van Eeckhout ◽  
...  
Keyword(s):  
Open Source ◽  
Predictive Models ◽  
Prediction Models ◽  
Patient Specific ◽  
Diagnosis And Prognosis ◽  
Online Calculator ◽  
User Friendly ◽  
Type 3 ◽  
Proof Of Principle

AbstractObjectiveThe current pandemic has led to a proliferation of predictive models being developed to address various aspects of COVID-19 patient care. We aimed to develop an online platform that would serve as an open source repository for a curated subset of such models, and provide a simple interface for included models to allow for online calculation. This platform would support doctors during decision-making regarding diagnoses, prognoses, and follow-up of COVID-19 patients, expediting the models’ transition from research to clinical practice.MethodsIn this proof-of-principle study, we performed a literature search in PubMed and WHO database to find suitable models for implementation on our platform. All selected models were publicly available (peer reviewed publications or open source repository) and had been validated (TRIPOD type 3 or 2b). We created a method for obtaining the regression coefficients if only the nomogram was available in the original publication. All predictive models were transcribed on a practical graphical user interface using PHP 8.0.0, and published online together with supporting documentation and links to the associated articles.ResultsThe open source website https://covid19risk.ai/ currently incorporates nine models from six different research groups, evaluated on datasets from different countries. The website will continue to be populated with other models related to COVID-19 prediction as these become available. This dynamic platform allows COVID-19 researchers to contact us to have their model curated and included on our website, thereby increasing the reach and real-world impact of their work.ConclusionWe have successfully demonstrated in this proof-of-principle study that our website provides an inclusive platform for predictive models related to COVID-19. It enables doctors to supplement their judgment with patient-specific predictions from externally-validated models in a user-friendly format. Additionally, this platform supports researchers in showcasing their work, which will increase the visibility and use of their models.

Real-Time Risk Tool for Pharmacy Interventions

2020 ◽  
pp. 001857872097388
Author(s):  
Hanh L. Nguyen ◽  
Kristin S. Alvarez ◽  
Boryana Manz ◽  
Arun Nethi ◽  
Varun Sharma ◽  
...  
Keyword(s):  
High Risk ◽  
Prediction Models ◽  
Risk Model ◽  
Hospital Readmissions ◽  
Group Versus ◽  
Safety Net ◽  
Low Risk ◽  
Day Hospital ◽  
Significant Difference ◽  
Safety Net Hospital

Background: Adverse drug events (ADEs) result in excess hospitalizations. Thorough admission medication histories (AMHs) may prevent ADEs; however, the resources required oftentimes outweigh what is available in large hospital settings. Previous risk prediction models embedded into the Electronic Medical Record (EMR) have been used at hospitals to aid in targeting delivery of scarce resources. Objective: To determine if an AMH scoring tool used to allocate resources can decrease 30-day hospital readmissions. Design, Setting, and Participants: Propensity-matched cohort study, Medicine/Surgery patients in large academic safety-net hospital. Intervention or Exposure: Pharmacy-conducted AMHs identified by risk model versus standard of care AMH. Main Outcomes and Measures: A total of 30-day hospital readmissions and inpatient ADE prevention. Results: The model screened 87 240 hospitalizations between June 2017 and June 2019 and 4027 patients per group were included. There were significantly less 30 day readmissions among high-risk identified patients that received a pharmacy-conducted AMH compared to controls (11% vs 15%; P = 0.004) and no significant difference in readmission rates for low-risk patients. While there was significantly higher documentation of major ADE prevention in the pharmacy-led AMH group versus control (1656 vs 12; P < 0.001), there was no difference in electronically-detected inpatient ADEs between groups. Conclusions: A risk tool embedded into the EMR can be used to identify patients whom pharmacy teams can easily target for AMHs. This study showed significant reductions in readmissions for patients identified as high-risk. However, the same benefit in readmissions was not seen in those identified at low-risk, which supports allocating resources to those that will benefit the most.

scholarly journals Application of Natural Language Processing on Character Computing : A Short Review

2021 ◽  
Author(s):  
KOUSHIK DEB
Keyword(s):  
Machine Learning ◽  
Deep Learning ◽  
Natural Language Processing ◽  
Natural Language ◽  
Language Processing ◽  
Personality Trait ◽  
Prediction Models ◽  
Short Review ◽  
Learning Techniques ◽  
Trait Prediction

Character Computing consists of not only personality trait recognition, but also correlation among these traits. Tons of research has been conducted in this area. Various factors like demographics, sentiment, gender, LIWC, and others have been taken into account in order to understand human personality. In this paper, we have concentrated on the factors that could be obtained from available data using Natural Language Processing. It has been observed that the most successful personality trait prediction models are highly dependent on NLP techniques. Researchers across the globe have used different kinds of machine learning and deep learning techniques to automate this process. Different combinations of factors lead the research in different directions. We have presented a comparative study among those experiments and tried to derive a direction for future development.

scholarly journals Enhancing Generalizability of Predictive Models with Synergy of Data and Physics

2021 ◽  
Author(s):  
Yingjun Shen ◽  
Zhe Song ◽  
Andrew Kusiak
Keyword(s):  
Machine Learning ◽  
Data Mining ◽  
Predictive Models ◽  
Prediction Models ◽  
Learning Algorithms ◽  
Machine Learning Algorithms ◽  
Predictive Maintenance ◽  
Divide And Conquer ◽  
Less Is More ◽  
Industrial Big Data

Abstract Wind farm needs prediction models for predictive maintenance. There is a need to predict values of non-observable parameters beyond ranges reflected in available data. A prediction model developed for one machine many not perform well in another similar machine. This is usually due to lack of generalizability of data-driven models. To increase generalizability of predictive models, this research integrates the data mining with first-principle knowledge. Physics-based principles are combined with machine learning algorithms through feature engineering, strong rules and divide-and-conquer. The proposed synergy concept is illustrated with the wind turbine blade icing prediction and achieves significant prediction accuracy across different turbines. The proposed process is widely accepted by wind energy predictive maintenance practitioners because of its simplicity and efficiency. Furthermore, the testing scores of KNN, CART and DNN algorithm are increased by 44.78%, 32.72% and 9.13% with our proposed process. We demonstrated the importance of embedding physical principles within the machine learning process, and also highlight an important point that the need for more complex machine learning algorithms in industrial big data mining is often much less than it is in other applications, making it essential to incorporate physics and follow “Less is More” philosophy.

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