J Am Med Inform Assoc - Development of a 5 year life expectancy index in older adults using predictive mining of electronic health record data.

Tópicos

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Resumo

JECTIVE: Incorporating accurate life expectancy predictions into clinical decision making could improve quality and decrease costs, but few providers do this. We sought to use predictive data mining and high dimensional analytics of electronic health record (EHR) data to develop a highly accurate and clinically actionable 5 year life expectancy index.MATERIALS AND METHODS: We developed the index using EHR data for 7463 patients =50 years old with =1 visit(s) in 2003 to a large, academic, multispecialty group practice. We extracted 980 attributes from the EHRs of the practices and affiliated hospitals. Correlation feature selection with greedy stepwise search was used to find the attribute subset with best average merit. Rotation forest ensembling with alternating decision tree as underlying classifier was used to predict 5 year mortality. Model performance was compared with the modified Charlson Comorbidity Index and the Walter life expectancy method.RESULTS: Within 5 years of the last visit in 2003, 838 (11%) patients had died. The final model included 24 attributes: two demographic (age, sex), 10 comorbidity (eg, cardiovascular disease), one vital sign (mean diastolic blood pressure), two medications (loop diuretic use, digoxin use), six laboratory (eg, mean albumin), and three healthcare utilization (eg, the number of hospitalizations 1 year prior to the last visit in 2003). The index showed very good discrimination (c-statistic 0.86) and outperformed comparators.CONCLUSIONS: The EHR based index successfully distinguished adults =50 years old with life expectancy >5 years from those with life expectancy =5 years. This information could be used clinically to optimize preventive service use (eg, cancer screening in the elderly).

Resumo Limpo

jectiv incorpor accur life expect predict clinic decis make improv qualiti decreas cost provid sought use predict data mine high dimension analyt electron health record ehr data develop high accur clinic action year life expect indexmateri method develop index use ehr data patient year old visit larg academ multispecialti group practic extract attribut ehr practic affili hospit correl featur select greedi stepwis search use find attribut subset best averag merit rotat forest ensembl altern decis tree under classifi use predict year mortal model perform compar modifi charlson comorbid index walter life expect methodresult within year last visit patient die final model includ attribut two demograph age sex comorbid eg cardiovascular diseas one vital sign mean diastol blood pressur two medic loop diuret use digoxin use six laboratori eg mean albumin three healthcar util eg number hospit year prior last visit index show good discrimin cstatist outperform comparatorsconclus ehr base index success distinguish adult year old life expect year life expect year inform use clinic optim prevent servic use eg cancer screen elder

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