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，许多患者对自己的疾病和药物缺乏了解，特别是在慢性疾病方面，美国每年约有三分之二的患者因慢性疾病的恶化而住院。住院后的出院说明是让患者参与自我护理的关键工具，但往往不成功。我们的假设是，为了让患者出院，应该提供个性化的住院总结，整合医生和护士的文件，并根据患者参与自我护理的水平和他们的社会文化观点。我们在医生和护士文档方面的变革试点工作已经确定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元辞典，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，而医生使用的术语只有15%。患者、医生和护士之间缺乏共同语言，这促使他们从各个角度来制定对患者有意义的指导。

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.