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

越来越多的研究发现，积极管理自己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，也有研究表明，许多患者缺乏对他们的疾病和药物的了解，特别是与慢性健康状况有关的知识，在美国，慢性健康状况的恶化每年导致约三分之二的住院。住院后的出院指导是让患者进行自我护理的关键工具，但往往不成功。我们的假设是，为了使患者在出院时达到年龄，应该提供个性化的住院总结，其中整合了医生和护士的记录，并根据患者的自我护理水平和他们的社会文化视角进行了解。我们关于医生和护士文档的变革性试点工作发现了从专业人员到患者的有效信息流动的另一个障碍：医生和护士之间的词汇差异。通过利用统一医学语言系统Metathesaurus，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%的患者使用的术语简单，而医生只有15%。患者、医生和护士之间缺乏共同语言，促使从各个角度对患者进行有意义的指导。 我们的假设是，更知情的患者群体了解他们的疾病、住院经历和出院指示之间的联系，将更有能力和更多地参与到他们的慢性病管理中。我们的创新是自动创建易于理解的个性化住院摘要，该摘要整合了EHR中描述的事件；并响应患者的需求和偏好以及他们的激活框架(PAF)级别。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，调查患者对疾病认知的社会文化模式；2.整合医生和护士提供的关于患者的多方面信息；3a.开发MyPHA，这是一个新型的应用程序，它将自动生成个性化的摘要，并在平板电脑上将其传递给患者。MyPHA将由目标1和目标2通知，并将以自然语言生成技术为基础；与所有利益相关者一起进行多个周期的形成性评估，并与患者进行终结性评估，以评估MyPHA。虽然我们的试点工作侧重于心力衰竭，但我们将开发的技术可以很容易地适用于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，癌症和心力衰竭可能会同时发生，特别是在老年患者中，几种癌症治疗方法可能会导致心力衰竭的发展。软件程序MyPHA将向研究社区开放源代码，以实现对其他慢性病的快速定制。

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.