Combining Natural Language Processing of Electronic Medical Notes With Administrative Data to Determine Racial/Ethnic Differences in the Disclosure and Documentation of Military Sexual Trauma in Veterans
Combining Natural Language Processing of Electronic Medical Notes With Administrative Data to Determine Racial/Ethnic Differences in the Disclosure and Documentation of Military Sexual Trauma in Veterans
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DOI：
10.1097/mlr.0000000000001031
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发表时间：
2019-06-01
期刊：
影响因子：
3
通讯作者：
Fargo, Jamison D.
中科院分区：
文献类型：
--
作者：
Gundlapalli, Adi, V;Jones, Audrey L.;Fargo, Jamison D.
背景：尽管进行了全国筛查，但军队性创伤（MST）的报道仍然不足。对于退伍军人健康管理局 (VHA) 的 MST 报告中的种族/民族差异知之甚少。目的：本研究旨在按种族/民族比较 VHA 中 MST 披露的模式。研究设计：对 2009 年 10 月至 2014 年在阿富汗和伊拉克服役并完成 MST 筛选的全国退伍军人随机样本进行 MST 披露的回顾性队列研究。我们在退伍军人第一次 MST 筛选后的一年内使用自然语言处理 (NLP) 从电子医疗记录中提取 MST 概念。措施：任何 MST 证据（积极 MST 筛选或 NLP 概念）和后期 MST 披露（消极 MST 筛选后的 NLP 概念）。多变量逻辑回归，按性别分层，测试任何 MST 证据中的种族/民族差异，以及延迟披露。结果：在 6618 名男性和 6716 名女性退伍军人中，有 MST 筛查结果，其中 1473 人筛查呈阳性（68 名男性，1%；1405 名女性，21%）。在筛查阴性的人中，有 257 人通过 NLP 证明了 MST 披露较晚（44 名男性，39%；213 名女性，13%）。迟到的 MST 披露通常是在心理健康就诊期间记录的。男性 MST 披露不存在显着的种族/民族差异。在女性中，黑人比白人更有可能获得 MST 证据（调整后的比值比 = 0.75）。在具有任何 MST 证据的子样本中，黑人和西班牙裔女性比白人更有可能较晚披露 MST（调整后的比值比分别为 1.89 和 1.59）。结论：将 NLP 结果与 MST 筛查数据相结合，有助于识别男性和少数种族/族裔女性中未报告的性创伤经历。
Background: Despite national screening efforts, military sexual trauma (MST) is underreported. Little is known of racial/ethnic differences in MST reporting in the Veterans Health Administration (VHA). Objective: This study aimed to compare patterns of MST disclosure in VHA by race/ethnicity. Research Design: Retrospective cohort study of MST disclosures in a national, random sample of Veterans who served in Afghanistan and Iraq and completed MST screens from October 2009 to 2014. We used natural language processing (NLP) to extract MST concepts from electronic medical notes in the year following Veterans' first MST screen. Measure(s): Any evidence of MST (positive MST screen or NLP concepts) and late MST disclosure (NLP concepts following a negative MST screen). Multivariable logistic regressions, stratified by sex, tested racial/ethnic differences in any MST evidence, and late disclosure. Results: Of 6618 male and 6716 female Veterans with MST screen results, 1473 had a positive screen (68 male, 1%; 1405 female, 21%). Of those with a negative screen, 257 evidenced late MST disclosure by NLP (44 male, 39%; 213 female, 13%). Late MST disclosure was usually documented during mental health visits. There were no significant racial/ethnic differences in MST disclosure among men. Among women, blacks were less likely than whites to have any MST evidence (adjusted odds ratio=0.75). In the subsample with any MST evidence, black and Hispanic women were more likely than whites to disclose MST late (adjusted odds ratio=1.89 and 1.59, respectively). Conclusions: Combining NLP results with MST screen data facilitated the identification of under-reported sexual trauma experiences among men and racial/ethnic minority women.