TY - JOUR
T1 - A quantitative approach for the analysis of clinician recognition of acute respiratory distress syndrome using electronic health record data
AU - Bechel, Meagan A.
AU - Pah, Adam R.
AU - Shi, Hanyu
AU - Mehrotra, Sanjay
AU - Persell, Stephen D.
AU - Weiner, Shayna
AU - Wunderink, Richard G.
AU - Nunes Amaral, Luís A.
AU - Weiss, Curtis H.
N1 - Funding Information:
This project was supported by the National Institute of General Medical Sciences, Grant T32GM008152 (MB); the National Heart, Lung, and Blood Institute, Grant K23HL118139 and Grant R01HL140362-01A1 (CHW); the Francis Family Foundation (Parker B. Francis Fellowship Program, CHW); the Department of Defense Army Research Office, Grant W911NF-14-1-0259 (MB, LANA, CHW); the National Center for Research Resources, Grant 5UL1RR025741, which is now at the National Center for Advancing Translational Sciences, Grant 8UL1TR000150 (Northwestern University Clinical and Translational Sciences Institute Enterprise Data Warehouse); and John and Leslie McQuown (LANA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Francis Family Foundation, or the Department of Defense. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
Publisher Copyright:
© 2019 Bechel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Importance Despite its efficacy, low tidal volume ventilation (LTVV) remains severely underutilized for patients with acute respiratory distress syndrome (ARDS). Physician under-recognition of ARDS is a significant barrier to LTVV use. We propose a computational method that addresses some of the limitations of the current approaches to automated measurement of whether ARDS is recognized by physicians. Objective To quantify patient and physician factors affecting physicians’ tidal volume selection and to build a computational model of physician recognition of ARDS that accounts for these factors. Design, setting, and participants In this cross-sectional study, electronic health record data were collected for 361 ARDS patients and 388 non-ARDS hypoxemic (control) patients in nine adult intensive care units at four hospitals between June 24 and December 31, 2013.Methods Standardized tidal volumes (mL/kg predicted body weight) were chosen as a proxy for physician decision-making behavior. Using data-science approaches, we quantified the effect of eight factors (six severity of illness, two physician behaviors) on selected standardized tidal volumes in ARDS and control patients. Significant factors were incorporated in computational behavioral models of physician recognition of ARDS. Results Hypoxemia severity and ARDS documentation in physicians’ notes were associated with lower standardized tidal volumes in the ARDS cohort. Greater patient height was associated with lower standardized tidal volumes (which is already normalized for height) in both ARDS and control patients. The recognition model yielded a mean (99% confidence interval) physician recognition of ARDS of 22% (9%-42%) for mild, 34% (19%-49%) for moderate, and 67% (41%-100%) for severe ARDS. Conclusions and relevance In this study, patient characteristics and physician behaviors were demonstrated to be associated with differences in ventilator management in both ARDS and control patients. Our model of physician ARDS recognition measurement accounts for these clinical variables, providing an electronic approach that moves beyond relying on chart documentation or resource intensive approaches.
AB - Importance Despite its efficacy, low tidal volume ventilation (LTVV) remains severely underutilized for patients with acute respiratory distress syndrome (ARDS). Physician under-recognition of ARDS is a significant barrier to LTVV use. We propose a computational method that addresses some of the limitations of the current approaches to automated measurement of whether ARDS is recognized by physicians. Objective To quantify patient and physician factors affecting physicians’ tidal volume selection and to build a computational model of physician recognition of ARDS that accounts for these factors. Design, setting, and participants In this cross-sectional study, electronic health record data were collected for 361 ARDS patients and 388 non-ARDS hypoxemic (control) patients in nine adult intensive care units at four hospitals between June 24 and December 31, 2013.Methods Standardized tidal volumes (mL/kg predicted body weight) were chosen as a proxy for physician decision-making behavior. Using data-science approaches, we quantified the effect of eight factors (six severity of illness, two physician behaviors) on selected standardized tidal volumes in ARDS and control patients. Significant factors were incorporated in computational behavioral models of physician recognition of ARDS. Results Hypoxemia severity and ARDS documentation in physicians’ notes were associated with lower standardized tidal volumes in the ARDS cohort. Greater patient height was associated with lower standardized tidal volumes (which is already normalized for height) in both ARDS and control patients. The recognition model yielded a mean (99% confidence interval) physician recognition of ARDS of 22% (9%-42%) for mild, 34% (19%-49%) for moderate, and 67% (41%-100%) for severe ARDS. Conclusions and relevance In this study, patient characteristics and physician behaviors were demonstrated to be associated with differences in ventilator management in both ARDS and control patients. Our model of physician ARDS recognition measurement accounts for these clinical variables, providing an electronic approach that moves beyond relying on chart documentation or resource intensive approaches.
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U2 - 10.1371/journal.pone.0222826
DO - 10.1371/journal.pone.0222826
M3 - Article
C2 - 31539417
AN - SCOPUS:85072530726
VL - 14
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 9
M1 - e0222826
ER -