Prevalence and Nature of Financial Considerations Documented in Narrative Clinical Records in Intensive Care Units
Prevalence and Nature of Financial Considerations Documented in Narrative Clinical Records in Intensive Care Units
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DOI：
10.1001/jamanetworkopen.2018.4178
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发表时间：
2018-11-01
影响因子：
13.8
通讯作者：
Perlis, Roy H.
中科院分区：
文献类型：
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作者：
Gordon, Deborah D.;Patel, Ihsaan;Perlis, Roy H.
重要性财务考虑改变重症监护室（ICU）决策的程度知之甚少。目的描述叙述性临床记录中记录的财务考虑的流行率和性质及其与患者水平的人口统计学和临床特征的相关性。和参与者将自然语言处理应用于重症监护医学信息集市的叙述性笔记的计算机模拟队列研究（MIMIC-III）研究。数据来自2001年6月1日至2012年10月31日期间住院的所有个体。结果在46146例ICU入院患者中，有1936例（4.2%）患者在ICU住院期间至少有1条记录反映了经济因素。在这1936例患者中，1135例（58.6%）为男性，平均（SD）年龄为38.8（28.4）岁，平均（SD）住院时间为21.7（27.1）天。在该队列的其余44210例住院患者中，24780例（56.1%）为男性，平均（SD）年龄为48.6（32.1）岁，平均（SD）住院时间为9.2（11.4）天。在46146例住院患者中，142例（0.3%）包括描述出院计划变更的注释，142例（0.3%）描述治疗计划变更的注释，303例（0.7%）描述药物变更或与经济考虑相关的既往不依从药物的注释。在logistic回归模型调整年龄，性别，婚姻状况，保险类型，较长的住院时间显着相关的存在的财务票据（比值比，1.01; 95%CI，1.01-1.01）。结论和相关性在这项研究中，在ICU的患者，临床笔记文件的关联性的财务考虑与护理决策。虽然这些笔记可能低估了这种考虑的频率，但它们强调需要制定更好的系统方法来了解财政限制如何改变美国卫生系统的护理决策。
IMPORTANCE The extent to which financial considerations alter intensive care unit (ICU) decision making is poorly understood.OBJECTIVES To characterize the prevalence and nature of financial considerations documented in narrative clinical records and their association with patient-level demographic and clinical features.DESIGN, SETTING, AND PARTICIPANTS In silico cohort study applying natural language processing to narrative notes from the Medical Information Mart for Intensive Care (MIMIC-Ill) study. Data from all individuals hospitalized between June 1, 2001, and October 31, 2012. in the ICU of Beth Israel Deaconess Medical Center were analyzed from April 1 to April 30, 2018.MAIN OUTCOMES AND MEASURE Presence of financial considerations in narrative dinical notes.RESULTS Among 46146 index ICU admissions, 1936 patients (4.2%) were identified with at least 1 note reflecting financial considerations during the ICU stay. Of these 1936 patients, 1135 (58.6%) were male, with a mean (SD) age of 38.8 (28.4) years and mean (SD) length of stay of 21.7 (27.1) days. Among the remaining 44 210 admissions in the cohort, 24780 (56.1%) were male, with a mean (SD) age of 48.6 (32.1) years and mean (SD) length of stay of 9.2 (11.4) days. Among the 46146 admissions, 142 (0.3%) included notes describing a change in the discharge plan, 142 (0.3%) describing a change in the treatment plan, and 303 (0.7%) describing a change in medication or previous non adherence to medication associated with financial considerations. In logistic regression models adjusted for age, sex, marital status, and insurance type, longer hospital stays were significantly associated with the presence of financial notes (odds ratio, 1.01; 95% Cl, 1.01-1.01).CONCLUSIONS AND RELEVANCE In this study, among patients in the ICU, clinical notes document the association of financial considerations with care decisions. Although such notes likely underestimate the frequency of such considerations, they highlight the need to develop better systematic approaches to understanding how financial constraints may alter care decisions in US health systems.