J Am Med Inform Assoc - Collaborative knowledge acquisition for the design of context-aware alert systems.

Tópicos

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{ detect(2391) sensit(1101) algorithm(908) }

Resumo

JECTIVE: To present a framework for combining implicit knowledge acquisition from multiple experts with machine learning and to evaluate this framework in the context of anemia alerts.MATERIALS AND METHODS: Five internal medicine residents reviewed 18 anemia alerts, while 'talking aloud'. They identified features that were reviewed by two or more physicians to determine appropriate alert level, etiology and treatment recommendation. Based on these features, data were extracted from 100 randomly-selected anemia cases for a training set and an additional 82 cases for a test set. Two staff internists assigned an alert level, etiology and treatment recommendation before and after reviewing the entire electronic medical record. The training set of 118 cases (100 plus 18) and the test set of 82 cases were explored using RIDOR and JRip algorithms.RESULTS: The feature set was sufficient to assess 93% of anemia cases (intraclass correlation for alert level before and after review of the records by internists 1 and 2 were 0.92 and 0.95, respectively). High-precision classifiers were constructed to identify low-level alerts (precision p=0.87, recall R=0.4), iron deficiency (p=1.0, R=0.73), and anemia associated with kidney disease (p=0.87, R=0.77).DISCUSSION: It was possible to identify low-level alerts and several conditions commonly associated with chronic anemia. This approach may reduce the number of clinically unimportant alerts. The study was limited to anemia alerts. Furthermore, clinicians were aware of the study hypotheses potentially biasing their evaluation.CONCLUSION: Implicit knowledge acquisition, collaborative filtering and machine learning were combined automatically to induce clinically meaningful and precise decision rules.

Resumo Limpo

jectiv present framework combin implicit knowledg acquisit multipl expert machin learn evalu framework context anemia alertsmateri method five intern medicin resid review anemia alert talk aloud identifi featur review two physician determin appropri alert level etiolog treatment recommend base featur data extract randomlyselect anemia case train set addit case test set two staff internist assign alert level etiolog treatment recommend review entir electron medic record train set case plus test set case explor use ridor jrip algorithmsresult featur set suffici assess anemia case intraclass correl alert level review record internist respect highprecis classifi construct identifi lowlevel alert precis p recal r iron defici p r anemia associ kidney diseas p rdiscuss possibl identifi lowlevel alert sever condit common associ chronic anemia approach may reduc number clinic unimport alert studi limit anemia alert furthermor clinician awar studi hypothes potenti bias evaluationconclus implicit knowledg acquisit collabor filter machin learn combin automat induc clinic meaning precis decis rule

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