J Am Med Inform Assoc - Patient-tailored prioritization for a pediatric care decision support system through machine learning.

Tópicos

{ patient(1821) servic(1111) care(1106) }
{ model(2341) predict(2261) use(1141) }
{ ehr(2073) health(1662) electron(1139) }
{ network(2748) neural(1063) input(814) }
{ model(3404) distribut(989) bayesian(671) }
{ clinic(1479) use(1117) guidelin(835) }
{ method(2212) result(1239) propos(1039) }
{ structur(1116) can(940) graph(676) }
{ risk(3053) factor(974) diseas(938) }
{ use(1733) differ(960) four(931) }
{ learn(2355) train(1041) set(1003) }
{ data(3963) clinic(1234) research(1004) }
{ monitor(1329) mobil(1314) devic(1160) }
{ model(2656) set(1616) predict(1553) }
{ medic(1828) order(1363) alert(1069) }
{ data(3008) multipl(1320) sourc(1022) }
{ cancer(2502) breast(956) screen(824) }
{ decis(3086) make(1611) patient(1517) }
{ can(774) often(719) complex(702) }
{ bind(1733) structur(1185) ligand(1036) }
{ general(901) number(790) one(736) }
{ search(2224) databas(1162) retriev(909) }
{ gene(2352) biolog(1181) express(1162) }
{ can(981) present(881) function(850) }
{ analysi(2126) use(1163) compon(1037) }
{ high(1669) rate(1365) level(1280) }
{ use(976) code(926) identifi(902) }
{ data(1737) use(1416) pattern(1282) }
{ imag(1057) registr(996) error(939) }
{ sequenc(1873) structur(1644) protein(1328) }
{ featur(3375) classif(2383) classifi(1994) }
{ studi(2440) review(1878) systemat(933) }
{ assess(1506) score(1403) qualiti(1306) }
{ control(1307) perform(991) simul(935) }
{ case(1353) use(1143) diagnosi(1136) }
{ studi(1410) differ(1259) use(1210) }
{ system(1050) medic(1026) inform(1018) }
{ compound(1573) activ(1297) structur(1058) }
{ perform(1367) use(1326) method(1137) }
{ health(3367) inform(1360) care(1135) }
{ result(1111) use(1088) new(759) }
{ survey(1388) particip(1329) question(1065) }
{ method(1969) cluster(1462) data(1082) }
{ imag(1947) propos(1133) code(1026) }
{ inform(2794) health(2639) internet(1427) }
{ system(1976) rule(880) can(841) }
{ measur(2081) correl(1212) valu(896) }
{ method(1219) similar(1157) match(930) }
{ imag(2830) propos(1344) filter(1198) }
{ imag(2675) segment(2577) method(1081) }
{ patient(2315) diseas(1263) diabet(1191) }
{ take(945) account(800) differ(722) }
{ motion(1329) object(1292) video(1091) }
{ treatment(1704) effect(941) patient(846) }
{ surgeri(1148) surgic(1085) robot(1054) }
{ framework(1458) process(801) describ(734) }
{ problem(2511) optim(1539) algorithm(950) }
{ error(1145) method(1030) estim(1020) }
{ chang(1828) time(1643) increas(1301) }
{ concept(1167) ontolog(924) domain(897) }
{ algorithm(1844) comput(1787) effici(935) }
{ extract(1171) text(1153) clinic(932) }
{ method(1557) propos(1049) approach(1037) }
{ data(1714) softwar(1251) tool(1186) }
{ design(1359) user(1324) use(1319) }
{ model(2220) cell(1177) simul(1124) }
{ care(1570) inform(1187) nurs(1089) }
{ method(984) reconstruct(947) comput(926) }
{ featur(1941) imag(1645) propos(1176) }
{ howev(809) still(633) remain(590) }
{ perform(999) metric(946) measur(919) }
{ research(1085) discuss(1038) issu(1018) }
{ import(1318) role(1303) understand(862) }
{ visual(1396) interact(850) tool(830) }
{ studi(1119) effect(1106) posit(819) }
{ blood(1257) pressur(1144) flow(957) }
{ spatial(1525) area(1432) region(1030) }
{ record(1888) medic(1808) patient(1693) }
{ model(3480) simul(1196) paramet(876) }
{ state(1844) use(1261) util(961) }
{ research(1218) medic(880) student(794) }
{ patient(2837) hospit(1953) medic(668) }
{ data(2317) use(1299) case(1017) }
{ age(1611) year(1155) adult(843) }
{ signal(2180) analysi(812) frequenc(800) }
{ cost(1906) reduc(1198) effect(832) }
{ group(2977) signific(1463) compar(1072) }
{ sampl(1606) size(1419) use(1276) }
{ first(2504) two(1366) second(1323) }
{ intervent(3218) particip(2042) group(1664) }
{ activ(1138) subject(705) human(624) }
{ time(1939) patient(1703) rate(768) }
{ use(2086) technolog(871) perceiv(783) }
{ health(1844) social(1437) communiti(874) }
{ drug(1928) target(777) effect(648) }
{ implement(1333) system(1263) develop(1122) }
{ estim(2440) model(1874) function(577) }
{ process(1125) use(805) approach(778) }
{ activ(1452) weight(1219) physic(1104) }
{ detect(2391) sensit(1101) algorithm(908) }

Resumo

JECTIVE: Over 8 years, we have developed an innovative computer decision support system that improves appropriate delivery of pediatric screening and care. This system employs a guidelines evaluation engine using data from the electronic health record (EHR) and input from patients and caregivers. Because guideline recommendations typically exceed the scope of one visit, the engine uses a static prioritization scheme to select recommendations. Here we extend an earlier idea to create patient-tailored prioritization.MATERIALS AND METHODS: We used Bayesian structure learning to build networks of association among previously collected data from our decision support system. Using area under the receiver-operating characteristic curve (AUC) as a measure of discriminability (a sine qua non for expected value calculations needed for prioritization), we performed a structural analysis of variables with high AUC on a test set. Our source data included 177 variables for 29 402 patients.RESULTS: The method produced a network model containing 78 screening questions and anticipatory guidance (107 variables total). Average AUC was 0.65, which is sufficient for prioritization depending on factors such as population prevalence. Structure analysis of seven highly predictive variables reveals both face-validity (related nodes are connected) and non-intuitive relationships.DISCUSSION: We demonstrate the ability of a Bayesian structure learning method to 'phenotype the population' seen in our primary care pediatric clinics. The resulting network can be used to produce patient-tailored posterior probabilities that can be used to prioritize content based on the patient's current circumstances.CONCLUSIONS: This study demonstrates the feasibility of EHR-driven population phenotyping for patient-tailored prioritization of pediatric preventive care services.

Resumo Limpo

jectiv year develop innov comput decis support system improv appropri deliveri pediatr screen care system employ guidelin evalu engin use data electron health record ehr input patient caregiv guidelin recommend typic exceed scope one visit engin use static priorit scheme select recommend extend earlier idea creat patienttailor prioritizationmateri method use bayesian structur learn build network associ among previous collect data decis support system use area receiveroper characterist curv auc measur discrimin sine qua non expect valu calcul need priorit perform structur analysi variabl high auc test set sourc data includ variabl patientsresult method produc network model contain screen question anticipatori guidanc variabl total averag auc suffici priorit depend factor popul preval structur analysi seven high predict variabl reveal facevalid relat node connect nonintuit relationshipsdiscuss demonstr abil bayesian structur learn method phenotyp popul seen primari care pediatr clinic result network can use produc patienttailor posterior probabl can use priorit content base patient current circumstancesconclus studi demonstr feasibl ehrdriven popul phenotyp patienttailor priorit pediatr prevent care servic

Resumos Similares

Artif Intell Med - Predicting the impact of hospital health information technology adoption on patient satisfaction. ( 0,647547439156808 )
Telemed J E Health - Teleconsultation for clinicians who provide human immunodeficiency virus care: experience of the national HIV telephone consultation service. ( 0,631134820406414 )
J Med Syst - Implementing telemedicine in medical emergency response: concept of operation for a regional telemedicine hub. ( 0,621740344601837 )
Telemed J E Health - Exploring the relationship among user satisfaction, compliance, and clinical outcomes of telemedicine services for glucose control. ( 0,621410010181974 )
J Telemed Telecare - Telehealth for nursing homes: the utilization of specialist services for residential care. ( 0,620519633511034 )
Telemed J E Health - Testing a top-down strategy for establishing a sustainable telemedicine program in a developing country: the Arizona telemedicine program-US Army-Republic of Panama Initiative. ( 0,615985405267184 )
J Telemed Telecare - A qualitative study of ethical, medico-legal and clinical governance matters in Australian telehealth services. ( 0,615718863509551 )
Telemed J E Health - Teledermatology via a social networking web site: a pilot study between a general hospital and a rural clinic. ( 0,614379759201825 )
J Telemed Telecare - Eleven years of experience with low-bandwidth telemedicine in a nurse-led rural clinic in Scotland. ( 0,610784271343773 )
J Telemed Telecare - A feasibility study of a telephone-based screening service for mild cognitive impairment and its uptake by elderly people. ( 0,610464825653676 )
BMC Med Inform Decis Mak - Teleconsultation in children with abdominal pain: a comparison of physician triage recommendations and an established paediatric telephone triage protocol. ( 0,61036171309212 )
J Am Med Inform Assoc - Computer-aided diagnosis of pneumonia in patients with chronic obstructive pulmonary disease. ( 0,610208431152864 )
AMIA Annu Symp Proc - Workflow concerns and workarounds of readers in an urban safety net teleretinal screening study. ( 0,608013684484673 )
Telemed J E Health - Online medical care: the current state of eVisits in acute primary care delivery. ( 0,60274752043234 )
J Telemed Telecare - A pharmacist-managed telemedicine clinic for hepatitis C care: a descriptive analysis. ( 0,601634709430897 )
Perspect Health Inf Manag - A peach of a telehealth program: Georgia connects rural communities to better healthcare. ( 0,601200267925542 )
J Telemed Telecare - A telemedicine network to support paediatric care in small hospitals in rural Tanzania. ( 0,595530509521543 )
Telemed J E Health - A mobile phone-based, community health worker program for referral, follow-up, and service outreach in rural Zambia: outcomes and overview. ( 0,594876021567461 )
J Telemed Telecare - Cost savings and safety of ICD remote control by telephone: a prospective, observational study. ( 0,59127605611132 )
Telemed J E Health - The Pacific Asynchronous TeleHealth (PATH) system: review of 1,000 pediatric teleconsultations. ( 0,590407941421109 )
J Telemed Telecare - Telehealth opportunities in regional Queensland: a scoping study. ( 0,588673400441398 )
Telemed J E Health - Telemedicine in an academic center--the Arizona Telemedicine Program. ( 0,587639885989536 )
J Telemed Telecare - Practical experience of telehealth between an Antarctic station and Japan. ( 0,583774095350835 )
Telemed J E Health - Evaluating the uptake, acceptability, and effectiveness of Uliza! clinicians' HIV hotline: a telephone consultation service in Kenya. ( 0,582325401903441 )
J Telemed Telecare - Patient adherence to recommendations after teleconsultation: survey of patients from a telemedicine centre in Switzerland. ( 0,582281022419179 )
J Telemed Telecare - Experience with telehealth for sleep monitoring and sleep laboratory management. ( 0,580995444724131 )
Telemed J E Health - Can an office practice telephonic response meet the needs of a pandemic? ( 0,580946820580859 )
BMC Med Inform Decis Mak - Formative evaluation of a telemedicine model for delivering clinical neurophysiology services part I: utility, technical performance and service provider perspective. ( 0,580628570916788 )
Telemed J E Health - The design, implementation, and operational management of a comprehensive quality management program to support national telehealth networks. ( 0,578722779593396 )
Telemed J E Health - Potential role of telemedical service centers in managing remote monitoring data transmitted daily by cardiac implantable electronic devices: results of the early detection of cardiovascular events in device patients with heart failure (detecT-Pilot) study. ( 0,578128332427437 )
Med Decis Making - Providing Informal Care in Terminal Illness: An Analysis of Preferences for Support Using a Discrete Choice Experiment. ( 0,577996070957358 )
Telemed J E Health - Acceptability of the consumer-centric u-health services for patients with chronic obstructive pulmonary disease. ( 0,577070765393959 )
Telemed J E Health - International telemedicine consultations for neurodevelopmental disabilities. ( 0,577013915960268 )
Telemed J E Health - Utilization of robotic remote presence technology within North American intensive care units. ( 0,576127534390895 )
Healthc (Amst) - Flipping primary health care: A personal story. ( 0,575382231815413 )
Telemed J E Health - Teledermatology operational considerations, challenges, and benefits: the referring providers' perspective. ( 0,574992763403687 )
J Telemed Telecare - A mobile telemedicine-enabled ear screening service for Indigenous children in Queensland: activity and outcomes in the first three years. ( 0,574120647292649 )
AMIA Annu Symp Proc - Using a service oriented architecture approach to clinical decision support: performance results from two CDS Consortium demonstrations. ( 0,573225463420741 )
Telemed J E Health - Comparison of parent satisfaction with care for childhood obesity delivered face-to-face and by telemedicine. ( 0,572349925786867 )
Telemed J E Health - Teledermatology patient satisfaction in the Pacific Northwest. ( 0,569555289418431 )
Artif Intell Med - A pilot study of distributed knowledge management and clinical decision support in the cloud. ( 0,569275490240709 )
J Telemed Telecare - Use of videoconferencing for consultation in dental prosthetics and oral rehabilitation. ( 0,567275003938133 )
Telemed J E Health - The feasibility of a community-based mobile telehealth screening service for Aboriginal and Torres Strait Islander children in Australia. ( 0,566589025783072 )
Telemed J E Health - Teleneurology: successful delivery of chronic neurologic care to 354 patients living remotely in a rural state. ( 0,562769487323908 )
AMIA Annu Symp Proc - COPD Hospitalization Risk Increased with Distinct Patterns of Multiple Systems Comorbidities Unveiled by Network Modeling. ( 0,562131103689842 )
J Telemed Telecare - Use of a mental health emergency care-rural access programme in emergency departments. ( 0,560447342563933 )
J Telemed Telecare - Trial of telemedicine for patients on home ventilator support: feasibility, confidence in clinical management and use in medical decision-making. ( 0,560391604874535 )
Int J Med Inform - Electronic decision protocols for ART patient triaging to expand access to HIV treatment in South Africa: a cross sectional study for development and validation. ( 0,558864711241733 )
J Telemed Telecare - Integration of e-consultations into the outpatient care process at a tertiary medical centre. ( 0,557253574462535 )
Telemed J E Health - Using telehealth to provide diabetes care to patients in rural Montana: findings from the promoting realistic individual self-management program. ( 0,556159328575667 )
Perspect Health Inf Manag - Exploring patient satisfaction before and after electronic health record (EHR) implementation: the Kuwait experience. ( 0,551483153269172 )
J. Med. Internet Res. - Video consultation use by Australian general practitioners: video vignette study. ( 0,549797708408092 )
Telemed J E Health - Telemedicine and telepresence for prehospital and remote hospital tracheal intubation using a GlideScope? videolaryngoscope: a model for tele-intubation. ( 0,549304946629066 )
AMIA Annu Symp Proc - Specialized Pediatric Growth Charts For Electronic Health Record Systems: the example of Down syndrome. ( 0,547585526734939 )
Telemed J E Health - Telemedicine--a complement to traditional referrals in oral medicine. ( 0,546759566568909 )
Telemed J E Health - TeleFIT: adapting a multidisciplinary, tertiary-care pediatric obesity clinic to rural populations. ( 0,546049350441553 )
J Telemed Telecare - Feasibility of providing nephrology services to remote communities with videoconferencing. ( 0,545841381880229 )
Telemed J E Health - Feasibility and acceptability of mobile epilepsy educational system (MEES) for people with epilepsy in Malaysia. ( 0,544589797725673 )
J Telemed Telecare - Transcultural telepsychiatry and its impact on patient satisfaction. ( 0,543991903407001 )
J Telemed Telecare - Validation of remote mapping of cochlear implants. ( 0,543686787339648 )
J Telemed Telecare - Use of home telehealth in palliative cancer care: a case study. ( 0,543672138584741 )
J Telemed Telecare - Effectiveness and safety of telemedical management in uncomplicated urinary tract infections. ( 0,543395451362573 )
J Am Med Inform Assoc - Using electronic health records to save money. ( 0,543221173928491 )
Int J Health Geogr - A brief report on Primary Care Service Area catchment geographies in New South Wales Australia. ( 0,542491253102346 )
J Telemed Telecare - A tele-oncology model replacing face-to-face specialist cancer care: perspectives of patients in North Queensland. ( 0,542144928922121 )
Telemed J E Health - Patients' satisfaction of healthcare services and perception with in-home telerehabilitation and physiotherapists' satisfaction toward technology for post-knee arthroplasty: an embedded study in a randomized trial. ( 0,541540193732322 )
Appl Clin Inform - Interest in health information exchange in ambulatory care: a statewide survey. ( 0,541510204991607 )
Telemed J E Health - Telehealth stroke education for rural elderly Virginians. ( 0,540940107316042 )
Telemed J E Health - Humour sans frontieres: the feasibility of providing clown care at a distance. ( 0,540727742709391 )
Telemed J E Health - Utilization, benefits, and impact of an e-consultation service across diverse specialties and primary care providers. ( 0,539207781796594 )
Methods Inf Med - Classification of postural profiles among mouth-breathing children by learning vector quantization. ( 0,53892992351204 )
Telemed J E Health - Improving stroke outcomes in rural areas through telestroke programs: an examination of barriers, facilitators, and state policies. ( 0,538921633121052 )
Telemed J E Health - The impact of telemedicine intensivist support and a pediatric hospitalist program on a community hospital. ( 0,537499851607608 )
Telemed J E Health - Video medical interpretation over 3G cellular networks: a feasibility study. ( 0,537378724796815 )
J Med Syst - A decision support tool for health service re-design. ( 0,536951894941134 )
Telemed J E Health - Telemedicine in acute-phase injury management: a review of practice and advancements. ( 0,535717353526961 )
Telemed J E Health - Primary care provider and imaging technician satisfaction with a teledermatology project in rural Veterans Health Administration clinics. ( 0,535638582319354 )
J Am Med Inform Assoc - Evaluation of computer-based medical histories taken by patients at home. ( 0,535602215502318 )
BMC Med Inform Decis Mak - Questionnaire survey about use of an online appointment booking system in one large tertiary public hospital outpatient service center in China. ( 0,534920062553586 )
Telemed J E Health - A regional prehospital electrocardiogram network with a single telecardiology hub for public emergency medical service: technical requirements, logistics, manpower, and preliminary results. ( 0,534173224809528 )
J Telemed Telecare - A randomized controlled trial of home telerehabilitation for post-knee arthroplasty. ( 0,53386217167182 )
Telemed J E Health - Implementation of a regional virtual tumor board: a prospective study evaluating feasibility and provider acceptance. ( 0,533655369384973 )
J Telemed Telecare - A telephone survey of patient satisfaction with realtime telemedicine in a rural community in Colombia. ( 0,533321664728174 )
AMIA Annu Symp Proc - Pediatric readmission classification using stacked regularized logistic regression models. ( 0,53269844105212 )
Telemed J E Health - A retrospective evaluation of remote pharmacist interventions in a telepharmacy service model using a conceptual framework. ( 0,532569022526269 )
BMC Med Inform Decis Mak - Reaching consensus on the physiotherapeutic management of patients following upper abdominal surgery: a pragmatic approach to interpret equivocal evidence. ( 0,530300470945338 )
Telemed J E Health - The telehealth satisfaction scale: reliability, validity, and satisfaction with telehealth in a rural memory clinic population. ( 0,530157484194231 )
Telemed J E Health - Technologies in the patient-centered medical home: examining the model from an enterprise perspective. ( 0,529623600664909 )
BMC Med Inform Decis Mak - Application of smart phone in Better Border Healthcare Program: a module for mother and child care. ( 0,528088901406552 )
J Telemed Telecare - The use of teleglaucoma at the University of Alberta. ( 0,52780314378254 )
Telemed J E Health - Telebation: next-generation telemedicine in remote airway management using current wireless technologies. ( 0,527578783120378 )
Int J Med Inform - Physician productivity and the ambulatory EHR in a large academic multi-specialty physician group. ( 0,525773160280034 )
Telemed J E Health - Online remote monitoring of patients with differentiated thyroid carcinomas and neuroendocrine tumors treated with high doses of radionuclides. ( 0,522943929401975 )
Appl Clin Inform - Exploring the value of clinical data standards to predict hospitalization of home care patients. ( 0,522095864633107 )
Perspect Health Inf Manag - Electronic health records and information portability: a pilot study in a rural primary healthcare center in India. ( 0,522006771346553 )
J Am Med Inform Assoc - Care transitions as opportunities for clinicians to use data exchange services: how often do they occur? ( 0,520325560028467 )
BMC Med Inform Decis Mak - Comparing virtual consults to traditional consults using an electronic health record: an observational case-control study. ( 0,520304808016971 )
J. Med. Internet Res. - Primary care providers' perspectives on online weight-loss programs: a big wish list. ( 0,519402469273326 )
Int J Med Inform - Virtualized healthcare delivery: understanding users and their usage patterns of online medical consultations. ( 0,5191147771916 )
Artif Intell Med - Multilevel Bayesian networks for the analysis of hierarchical health care data. ( 0,517324933785374 )