Luther Stephen L, Thomason Susan S, Sabharwal Sunil, Finch Dezon K, McCart James, Toyinbo Peter, Bouayad Lina, Matheny Michael E, Gobbel Glenn T, Powell-Cope Gail
Center of Innovation on Disability and Rehabilitation Research, Health Services Research and Development, Department of Veterans Affairs, Tampa, FL, United States.
College of Public Health, University of South Florida, Tampa, FL, United States.
JMIR Res Protoc. 2017 Jan 19;6(1):e3. doi: 10.2196/resprot.5948.
Pressure ulcers (PrUs) are a frequent, serious, and costly complication for veterans with spinal cord injury (SCI). The health care team should periodically identify PrU risk, although there is no tool in the literature that has been found to be reliable, valid, and sensitive enough to assess risk in this vulnerable population.
The immediate goal is to develop a risk assessment model that validly estimates the probability of developing a PrU. The long-term goal is to assist veterans with SCI and their providers in preventing PrUs through an automated system of risk assessment integrated into the veteran's electronic health record (EHR).
This 5-year longitudinal, retrospective, cohort study targets 12,344 veterans with SCI who were cared for in the Veterans Health Administration (VHA) in fiscal year (FY) 2009 and had no record of a PrU in the prior 12 months. Potential risk factors identified in the literature were reviewed by an expert panel that prioritized factors and determined if these were found in structured data or unstructured form in narrative clinical notes for FY 2009-2013. These data are from the VHA enterprise Corporate Data Warehouse that is derived from the EHR structured (ie, coded in database/table) or narrative (ie, text in clinical notes) data for FY 2009-2013.
This study is ongoing and final results are expected in 2017. Thus far, the expert panel reviewed the initial list of risk factors extracted from the literature; the panel recommended additions and omissions and provided insights about the format in which the documentation of the risk factors might exist in the EHR. This list was then iteratively refined through review and discussed with individual experts in the field. The cohort for the study was then identified, and all structured, unstructured, and semistructured data were extracted. Annotation schemas were developed, samples of documents were extracted, and annotations are ongoing. Operational definitions of structured data elements have been created and steps to create an analytic dataset are underway.
To our knowledge, this is the largest cohort employed to identify PrU risk factors in the United States. It also represents the first time natural language processing and statistical text mining will be used to expand the number of variables available for analysis. A major strength of this quantitative study is that all VHA SCI centers were included in the analysis, reducing potential for selection bias and providing increased power for complex statistical analyses. This longitudinal study will eventually result in a risk prediction tool to assess PrU risk that is reliable and valid, and that is sensitive to this vulnerable population.
压疮是脊髓损伤（SCI）退伍军人中常见、严重且代价高昂的并发症。医疗团队应定期识别压疮风险，尽管文献中尚未发现有足够可靠、有效且敏感的工具来评估这一脆弱人群的风险。
近期目标是开发一种风险评估模型，有效估计发生压疮的概率。长期目标是通过集成到退伍军人电子健康记录（EHR）中的自动化风险评估系统，协助SCI退伍军人及其医疗服务提供者预防压疮。
这项为期5年的纵向、回顾性队列研究针对2009财年在退伍军人健康管理局（VHA）接受治疗且在过去12个月内无压疮记录的12344名SCI退伍军人。文献中确定的潜在风险因素由一个专家小组进行审查，该小组对因素进行了优先级排序，并确定这些因素在2009 - 2013财年的结构化数据或叙事性临床记录中的非结构化形式中是否存在。这些数据来自VHA企业数据仓库，该仓库源自2009 - 2013财年的EHR结构化（即数据库/表中编码）或叙事性（即临床记录中的文本）数据。
本研究正在进行中，预计2017年得出最终结果。到目前为止，专家小组审查了从文献中提取的初始风险因素列表；该小组建议了增减内容，并提供了关于风险因素文档在EHR中可能存在的格式方面的见解。然后通过审查对该列表进行迭代完善，并与该领域的个别专家进行了讨论。随后确定了研究队列，并提取了所有结构化、非结构化和半结构化数据。开发了注释模式，提取了文档样本，注释工作正在进行中。已创建结构化数据元素的操作定义，创建分析数据集的步骤正在进行中。
据我们所知，这是美国用于识别压疮风险因素的最大队列。它也是首次将自然语言处理和统计文本挖掘用于扩大可用于分析的变量数量。这项定量研究的一个主要优势是，所有VHA SCI中心都纳入了分析，减少了选择偏倚的可能性，并为复杂的统计分析提供了更大的效力。这项纵向研究最终将产生一种可靠、有效的压疮风险评估预测工具，且对这一脆弱人群敏感。
