SCH: INT: MyPHA: Automatically generating personalized accounts of in-patient hospitalization

越来越多的研究发现，积极管理健康的患者会有更好的结果，患者参与已成为最近医疗保健方法的核心原则。然而，它也表明，许多患者缺乏对他们的疾病和药物的了解，特别是关于慢性健康状况，其恶化导致美国每年约三分之二的住院治疗。住院后的出院指导是让患者参与自我护理的重要工具，但往往不成功。我们的假设是，为了使患者在出院时能够康复，应该提供一份个性化的住院总结，该总结整合了医生和护士的文件，并根据患者的自我护理参与程度和他们的社会文化观点进行通报。我们在医生和护士文档方面的变革性试点工作已经确定了从专业人员到患者的有效信息流的另一个障碍：医生和护士之间的词汇差异。通过利用统一医学语言系统元词库，我们发现75%的患者的医生和护士文档之间没有共同的同义词。此外，86%的患者使用的术语是简单的，而医生只有15%。患者、医生和护士之间缺乏共同语言，促使包括所有观点在内的指导对患者有意义。 我们的假设是，一个更好地了解他们的疾病，医院经验和出院指示之间的联系的患者群体将更有权力，更积极地参与他们的慢性病管理。我们的创新是自动创建一个易于理解的个性化住院摘要，该摘要集成了EHR中描述的事件;并且响应患者的需求和偏好以及他们的激活框架（PAF）水平。我们追求四个具体目标：1。通过对患者访谈的社会语言学分析，探讨患者对疾病认知的社会文化模式;整合医生和护士提供的关于患者的多方面信息; 3a.开发MyPHA，一种新型的应用程序，它将自动生成个性化的摘要，并将其发送到平板电脑上的患者。MyPHA将以目标1和2为基础，并将以自然语言生成技术为基础; 3b.通过与所有利益相关者进行多个周期的形成性评价和与患者进行总结性评价来评价MyPHA。虽然我们的试点工作集中在心力衰竭，但我们将开发的技术可以很容易地适应其他慢性健康状况的管理，特别是癌症患者和癌症幸存者。此外，癌症和心力衰竭可以同时发生，特别是在老年患者中，并且几种癌症治疗可以导致心力衰竭的发展。软件程序MyPHA将开源发布给研究社区，以实现对其他慢性疾病的快速定制。

A growing body of research has found that patients who actively manage their health have better outcomes, and patient engagement has become a central tenet in recent healthcare approaches. However, it has also been shown that many patients lack knowledge of their disease and medications, particularly as concerns chronic health conditions, whose exacerbation causes about two thirds of hospitalizations every year in the USA. Discharge instructions after hospitalization are a critical tool to engage patients in their self-care, but are often unsuccessful. Our hypothesis is that, to en9age patients at discharge, a personalized hospitalization summary should be provided, that integrates physician and nurse documentation, and is informed by the patient's level of engagement in self-care and their socio-cultural perspective. Our transformative pilot work on physician and nurse documentation has identified an additional obstacle to the effective flow of information from professionals to patients: vocabulary differences between physicians and nurses. By leveraging the Unified Medical Language System Metathesaurus, we found no common synonyms between physician and nurse documentations for 75% of patients. Further, 86% of terms patients use are simple compared to only 15% for physicians. The lack of common language among patients, physicians and nurses motivates including all perspectives to make instructions meaningful for patients. Our hypothesis is that a better informed patient population who understands the connections between their illness, hospital experience, and discharge instructions will be more empowered and more engaged in their chronic disease management. Our innovation is to automatically create an easy-to-understand, personalized hospitalization summary that integrates events described in the EHR; and that is responsive to the patient's needs and preferences, and their activation framework (PAF) level. We pursue four specific aims: 1. To investigate socio-cultural patterns of patient perceptions of illness via a socio linguistic analysis of patient interviews; 2. To integrate multi-faceted information about a patient, as provided by physicians and nurses; 3a. To develop MyPHA, a novel application program, which will automatically generate the personalized summaries and deliver them to the patient on a tablet. MyPHA will be informed by aims 1 and 2, and will be grounded in Natural Language Generation technology; 3b. To evaluate MyPHA with multiple cycles of formative evaluation with all stakeholders, and a summative evaluation with patients. Whereas our pilot work has focused on heart failure, the techniques we will develop can easily be adapted to the management of other chronic health conditions, in particular for patients with cancer and cancer survivors. In addition, cancer and heart failure can co-occur, especially in older patients, and several cancer treatments can lead to the development of heart failure. The software program MyPHA will be released open source to the research community to enable rapid customization to other chronic conditions.