Enhanced Ascertainment of Asthma Status Via Natural Language Processing

 描述（由申请人提供）：据估计，几乎一半的美国人患有慢性疾病，但流行病学调查受到难以大规模确定疾病状态的限制，即使在电子病历（EMR）时代也是如此。例如，基于结构化数据的算法（例如，ICD-9编码）缺乏基于人群的研究所需的敏感性，而人工病历审查的EMR是劳动密集型的，因此效率低下的人口规模的疾病状态的确定。缺乏有效的方法来确定疾病状态，严重限制了对慢性疾病如哮喘的调查范围。此外，患者的真实疾病状态存在时间进展，并且这可能不会反映在该疾病的临床诊断中。我们以前报道过，三分之二的哮喘儿童的诊断延迟（中位数：3.3年），随后的情况如缓解或复发基本上没有报道。这些关于疾病进展的信息可以在手动病历审查期间记录，但是，手动审查再次将调查和结论限制在小规模研究中。我们的长期目标是通过简化医疗记录审查，加快慢性疾病及其时间进展的流行病学调查。该提案的主要目标是通过确定哮喘发作、缓解和复发的时间分类，扩展初步的基于NLP的哮喘状态确定系统。我们将在人口健康环境中验证该系统，并将其作为开源工具发布。我们假设EMR中的NLP方法使我们能够确定哮喘状态并跟踪哮喘疾病进展，其准确性和效率高于传统方法（账单代码或手动病历审查）。在目标1中，我们将扩展我们初步的NLP系统，以确定哮喘患者水平的疾病进展。最重要的是，我们将确定哮喘缓解和复发的时间，这是哮喘自然史中的两个重要事件。我们还将改进聚合事件的方法，采用时态表达和关系提取，包括结构化数据源，并实现自动特征选择。在目标2中，我们将评估NLP系统在确定哮喘发作、复发和缓解方面的准确性。我们还将验证现有研究的流行病学（结构）有效性，并将NLP系统作为开源项目Adept（患者时间表的疾病证据聚合）进行传播。预期结果：拟议的NLP系统将：（i）将临床NLP技术定位于时间定位的患者级解决方案;（ii）扩大哮喘研究能力的规模;（iii）为决策支持和其他应用提供基础。该项目的成功完成将为确定哮喘的疾病进展提供一个开源工具，并提供一种汇总证据的一般方法。

 DESCRIPTION (provided by applicant): It is estimated that almost one-half of Americans suffer from chronic diseases, yet epidemiologic investigations are limited by the difficulty of ascertaining disease status at scale, even in the era of electronic medical records (EMRs). For example, algorithms based on structured data (e.g., ICD-9 codes) for asthma lack the sensitivity required for population-based studies, while manual medical record reviews of EMRs are labor-intensive and thus inefficient for population-scale ascertainment of disease status. The lack of efficient ways to ascertain disease status has severely restricted the scope of investigation for chronic diseases such as asthma. Furthermore, there is a temporal progression of a patient's true disease status, and this may not be reflected in the clinical diagnosis of that disease. We previously reported that two-thirds of children with asthma had a delay in their diagnosis (median: 3.3 years), with subsequent conditions like remission or relapse largely unreported. Such information about disease progression may be recorded during manual medical record review, but, again, manual review limits investigations and conclusions to small-scale studies. Our long term goal is to accelerate epidemiological investigations of chronic diseases and their temporal progression by streamlining medical record review. The main goal of this proposal is to extend a preliminary NLP-based system for asthma status ascertainment by identifying time-situated classifications of asthma onset, remission, and relapse. We will validate this system in a population health setting and release it as an open-source tool. We hypothesize that NLP methods in the EMR allow us to ascertain asthma status and to track asthma disease progression with greater accuracy and efficiency than conventional approaches (billing codes or manual medical record review). In Aim 1, we will extend our preliminary NLP system to ascertain the patient-level disease progression of asthma. Most significantly, we will ascertain time-situated asthma remission and relapse, two important events in the natural history of asthma. We will also improve methods of aggregating events, employ temporal expression and relation extraction, include structured data sources, and implement automatic feature selection. In Aim 2, we will evaluate the NLP system for its accuracy in ascertaining asthma onset, relapse, and remission. We will also verify the epidemiological (construct) validity against existing studies, and disseminate the NLP system as an open-source project, Adept (Aggregation of Disease Evidence for Patient Timelines). Expected Outcomes: The proposed NLP system will: (i) orient clinical NLP techniques toward time-situated patient-level solutions; (ii) expand the scale of research capabilities for asthma; and (iii) provide a basis for decision support and other applications. Successful completion of this project would provide an open-source tool for ascertaining the disease progression of asthma with a general approach to aggregating evidence.