An Electronic Health Record-Based Tool to Identify Newly Diagnosed Breast Cancer Patients at Risk of Low Social Support

一种基于电子健康记录的工具，用于识别新诊断的乳腺癌患者面临社会支持低的风险

• 批准号: 10408831
• 负责人: CANDYCE H KROENKE
• 金额: $ 53.83万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10408831
• 关键词: Academy; Address; African American; Area; Asian; Asian Pacific Islander; Black race; Breast Cancer Patient; Breast Cancer Treatment; California; Cancer Research Network; Caring; Clinical; Code; Cohort Studies; Data; Data Collection; Development; Diagnosis; Documentation; Electronic Health Record; Emergency Situation; Ethnic Origin; Ethnic group; Funding; Health; Healthcare Systems; Hispanic; Information Technology; Intervention; Language; Linear Regressions; Link; Literature; Logistic Regressions; Logistics; Marital Status; Measures; Medical; Medical Care Team; Medical Records; Medicine; Minority Women; Natural Language Processing; Newly Diagnosed; Not Hispanic or Latino; Operative Surgical Procedures; Outcome; Pathway interactions; Patient Care; Patient risk; Patient-Focused Outcomes; Patients; Perception; Pilot Projects; Population; Provider; Publishing; Questionnaires; ROC Curve; Race; Recommendation; Research; Research Personnel; Resources; Risk; Services; Social Conditions; Social Network; Social support; Source; Structure; Text; Treatment outcome; Woman; Work; analytical method; anticancer research; base; cancer care; cancer health disparity; chemotherapy; clinical care; clinically relevant; cohort; ethnic diversity; hazard; health care settings; high risk; hormone therapy; improved; improved outcome; malignant breast neoplasm; mortality; patient response; racial and ethnic; racial and ethnic disparities; racial diversity; social; social computing; social health determinants; social relationships; social structure; structured data; theories; tool; unstructured data

ABSTRACT Social support, a social determinant of health (SDoH), is a definitive predictor of breast cancer (BC) treatment and mortality outcomes. Because of the recognition that social support is critical to BC patient outcomes, clinicians within Kaiser Permanente Northern California (KPNC) have documented information on social support in the electronic health record (EHR) since the advent of Epic in 2005. However, no EHR-based social support measure currently exists to help clinicians identify patients at high risk of low social support. Such a measure has high relevance for addressing racial/ethnic disparities in BC treatment and outcomes. Therefore, we propose to develop an Electronic Health Record Social Support Patient Risk Tool (EHR-SUPPORT) that could be used to identify women with BC at risk of low social support for referral to social support resources. We propose to: 1) Identify terms in the EHR, based on theory and prior literature, and informed by KPNC stakeholders in BC care, that reflect structural and/or functional social support, and have been associated with BC treatment and outcomes; 2) Develop EHR-SUPPORT, using structured, semi-structured, and unstructured data (to include natural language processing of text) that identifies patients at risk of low social support, overall and by race/ethnicity, and validate the measure against published social support measures; and 3) Evaluate associations of EHR-SUPPORT and its component variables with BC treatment (surgery and chemotherapy delays, nonadherence to hormonal therapy) and BC-specific and total mortality, overall and by race/ethnicity in 44,348 women diagnosed with stage I-IV BC within Kaiser Permanente Northern California between 2006- 2023 including 3,450 Black, 4,441 Hispanic, 6,571 Asian women, and 28,589 non-Latina white women. In an exploratory aim, we will develop, with KP clinician stakeholders, steps to the implementation of EHR- SUPPORT. We will review 100 medical records (25 in each race/ethnic group) within two months of diagnosis, informed by investigator expertise and clinician stakeholders, to develop terms used to describe patient support. In addition to developing structured data, we will use natural language processing of text fields to further develop social support indicators (Aim 1). EHR-SUPPORT will be computed from social support indicators; we will use linear and logistic regression to validate the developed measure against established social support measures in Pathways, a well-established cohort of 4,505 women with BC and use factor analytic and confirmatory factor analytic methods as well as ROC curves to further evaluate the score (Aim 2). We will use linear, logistic, and Cox proportional hazards regression to evaluate associations in Aim 3. The unique convergence of EHR and cohort data provides the first opportunity to develop and validate an EHR- based social support measure in in diverse women with BC, adjusted for an extensive set of covariates. This work is central to identifying patients at elevated risk of low social support and to enhancing social support- cancer research needed to improve clinical care and reduce BC disparities.

摘要