Development of an algorithm to assess unmeasured symptom severity in gynecologic care.
Development of an algorithm to assess unmeasured symptom severity in gynecologic care.
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DOI：
10.1016/j.ajog.2021.11.020
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发表时间：
2022-03
影响因子：
9.8
通讯作者：
Robinson WR
中科院分区：
文献类型：
--
作者：
Doll KM;Howard AG;Stürmer T;Carey T;Nicholson WK;Carey E;Myers E;Nerenz D;Robinson WR
Disparities research is often limited by incomplete accounting for differences in health status by populations. In the U.S., hysterectomy shows marked variation by race and geography, but it is difficult to understand what factors cause these variations without accounting for differences in the severity of gynecologic symptoms that drive hysterectomy decision-making. Our objective is to demonstrate a method for using electronic health record (EHR)-derived data to create composite symptom severity indices to more fully capture relevant markers that influence the decision for hysterectomy. This was a retrospective cohort study of 1,993 people who underwent hysterectomy between April 4, 2014 and December 31, 2017 from ten hospitals and over 100 outpatient clinics in North Carolina. EHR data including billing, pharmacy, laboratory data, and free text notes, were used to identify markers of 3 common indications for hysterectomy: bulk symptoms (pressure from uterine enlargement), vaginal bleeding, and pelvic pain. To develop weighted symptom indices, we finalized a scoring algorithm based on the relationship of each marker to an objective measure, in combination with clinical expertise, with the goal of composite symptom severity indices that had sufficient variation to be useful in comparing different patient groups and allow discrimination between more or less severe symptoms of bulk, bleeding, or pain. Ranges of symptom severity scores varied across the three indices; including composite bulk score (0 to 14), vaginal bleeding score (0 to 44) and pain score (0 to 30). Mean values of each composite symptom severity index were greater for those who had diagnostic codes for vaginal bleeding, bulk symptoms, or pelvic pain, respectively. However, each index also demonstrated variation across the entire group of hysterectomy cases and identified symptoms that ranged in severity among those with and without the target diagnostic codes. Leveraging multisource data to create composite symptom severity indices provided greater discriminatory power to assess common gynecologic indications for hysterectomy. These methods can advance understanding in healthcare use in the setting of long-standing inequities and be applied across populations to account for previously unexplained variation across race, geography, and other social indicators.
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影响因子：
7.2
作者：
通讯作者：
--
影响因子：
7.2
作者：
通讯作者：
--
影响因子：
3.2
作者：
Weiss, Gerson;Noorhasan, Dorette;Johnston, Janet M.
通讯作者：
Johnston, Janet M.
DOI：
10.1111/1471-0528.13273
发表时间：
2015-04
期刊：
BJOG : an international journal of obstetrics and gynaecology
影响因子：
--
作者：
Matteson KA;Scott DM;Raker CA;Clark MA
通讯作者：
Clark MA
影响因子：
9.8
作者：
Jacoby VL;Fujimoto VY;Giudice LC;Kuppermann M;Washington AE
通讯作者：
Washington AE