Using Machine Learning and Patient-Reported Outcomes to Identify Unnecessary Hospitalizations

使用机器学习和患者报告的结果来识别不必要的住院治疗

• 批准号: 10509614
• 负责人: Richard K Leuchter
• 金额: $ 11.19万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-05 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10509614
• 关键词: Accident and Emergency department; Address; Admission activity; Affect; Ambulatory Care; Award; COVID-19; COVID-19 pandemic; Cardiopulmonary; Caring; Cause of Death; Characteristics; Chronic Obstructive Pulmonary Disease; Clinical; Code; Dangerousness; Data; Defensive Medicine; Disadvantaged; Disease; Electronic Health Record; Emergency department visit; Ensure; Exposure to; Faculty; Foundations; Fright; Future; Goals; Health; Health Expenditures; Health Services Research; Healthcare; Heart failure; Hospitalization; Hospitals; Human; Inpatients; Internal Medicine; Judgment; K-Series Research Career Programs; Knowledge; Learning; Machine Learning; Measures; Mediating; Medical; Medical Errors; Medical Waste; Medicine; Methods; Modeling; Morals; Morbidity - disease rate; Myocardial Infarction; National Heart, Lung, and Blood Institute; Natural experiment; Outcome; Outcome Measure; Outpatients; Patient Care; Patient Outcomes Assessments; Patients; Performance; Physicians; Pneumonia; Principal Investigator; Provider; Publishing; Randomized; Recovery; Reporting; Research; Research Personnel; Research Training; Risk; Running; SARS coronavirus; Scientist; Sensitivity and Specificity; Shortness of Breath; Source; Stroke; Symptoms; Testing; Time; Training; Uncertainty; Vulnerable Populations; Work; adjudicate; arm; career; career development; cost; ethnic minority; experience; hazard; health care disparity; health equity; improved; innovation; inpatient service; learning outcome; machine learning model; machine learning prediction; marginalized population; mortality; overtreatment; pandemic disease; performance tests; pilot trial; point of care; predictive modeling; programs; prospective; racial and ethnic; racial minority; response; skills; success; tool; unethical

PROJECT SUMMARY/ABSTRACT I (Richard K. Leuchter, MD) am a UCLA Internal Medicine resident who will be joining the faculty as a clinician- scientist at UCLA in July 2022. I will practice hospital medicine and pursue health services research focused on identifying and reducing medical waste - patient care that provides no net benefit in certain clinical scenarios, and can also cause harm. I will build upon the excellent health services research training I received through the R38 StARR program, and continue my research using machine learning (ML) to identify and minimize medical waste. Unnecessary hospitalizations represent one of the single largest reservoirs of medical waste and disproportionately burden racial and ethnic minorities, but efforts to address this problem have been hindered by a lack of measures that can prospectively identify hospitalizations as unnecessary with acceptable accuracy. A critical barrier to measuring and reducing unnecessary hospitalizations is that claims data (e.g., billing information submitted to payers) lack enough clinical detail to accurately classify a hospitalization as “unnecessary.” Supplementing claims data with richer electronic health record (EHR) data offers potential to improve predictive accuracy, but EHR data do not routinely include discrete patient-reported outcomes (PROs) to quantify recovery from subjective symptoms (e.g., shortness of breath), making it difficult to adjudicate the necessity of admissions for diseases such as heart failure or pneumonia. To advance my career goals and work toward my overall aim of reducing the harms arising from wasteful medical practices (especially among disadvantaged patients), I propose a new method to identify unnecessary hospitalizations: train predictive ML models from EHR data that can identify admissions with a high likelihood of being unnecessary, and then assess model performance using a combination of clinical PROs and EHR outcomes. My overarching goal is to reduce wasteful and inequitable healthcare practices by becoming a leading principal investigator developing innovative and state of the art methods to minimize medical waste. To achieve this goal, I seek support from the NHLBI K38 Career Development Award. I will acquire skills in coding and using ML to predict health outcomes, measuring and analyzing PROs, and health/healthcare disparities research. I propose two specific research aims that align with my career development goals: 1) develop ML models that can identify Emergency Department (ED) admissions for cardiopulmonary illnesses with a high likelihood of being unnecessary, and 2) measure the prospective performance of these models using a combination of PROs and EHR data that will be collected from patients presenting to the ED. I will apply knowledge learned from my training to accomplish these aims, and plan to use the products of this research to inform an NHLBI K23 proposal for a single center pragmatic pilot trial that I plan to submit in 2023. The K38 Award would provide me with the training and skills needed to become a national leader in using emerging methods to reduce medical waste and its associated healthcare disparities.

项目概要/摘要 我（Richard K. Leuchter，医学博士）是加州大学洛杉矶分校内科住院医师，将以临床医生的身份加入该学院- 2022 年 7 月成为加州大学洛杉矶分校的科学家。我将从事医院医学工作并从事以健康服务为重点的研究 识别和减少医疗废物 - 在某些临床中不提供净效益的患者护理 场景，也可能造成伤害。我将在我接受的优秀卫生服务研究培训的基础上继续发展 通过 R38 StARR 计划，并使用机器学习 (ML) 继续我的研究来识别和 最大限度地减少医疗废物。不必要的住院治疗是最大的医疗储备库之一 浪费并给少数种族和族裔带来不成比例的负担，但解决这一问题的努力一直在 由于缺乏可以前瞻性地确定住院治疗为不必要且可接受的措施而受到阻碍 准确性。衡量和减少不必要住院的一个关键障碍是索赔数据（例如， 提交给付款人的账单信息）缺乏足够的临床细节来准确地将住院分类为 “不必要。”用更丰富的电子健康记录 (EHR) 数据补充索赔数据可以提供以下潜力： 提高预测准确性，但 EHR 数据通常不包括离散的患者报告结果 (PRO) 量化主观症状（例如呼吸短促）的恢复情况，这使得很难判断 因心力衰竭或肺炎等疾病入院的必要性。为了推进我的职业目标和 努力实现我的总体目标，即减少浪费的医疗实践（尤其是在 弱势患者），我提出了一种新方法来识别不必要的住院治疗：训练预测机器学习 来自 EHR 数据的模型可以识别很有可能是不必要的入院，然后 结合临床 PRO 和 EHR 结果评估模型性能。我的首要目标是 成为领先的首席研究员，减少浪费和不公平的医疗保健实践 开发创新和最先进的方法来最大限度地减少医疗废物。 为了实现这一目标，我寻求 NHLBI K38 职业发展奖的支持。我将获得以下方面的技能 编码并使用 ML 来预测健康结果、测量和分析 PRO 以及健康/医疗保健 差异研究。我提出了两个与我的职业发展目标相一致的具体研究目标：1） 开发可以识别急诊室 (ED) 因心肺疾病入院的 M​​L 模型 很可能是不必要的，并且 2）衡量这些模型的预期性能 结合 PRO 和 EHR 数据，这些数据将从向 ED 就诊的患者收集。我会 应用从我的培训中学到的知识来实现​​这些目标，并计划使用此产品 我计划在 2023 年提交一项 NHLBI K23 单中心实用试点试验提案。 K38 奖将为我提供成为国家领导者所需的培训和技能 减少医疗废物及其相关医疗保健差异的新兴方法。