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Feasibility of Extracting Meaningful Patient Centered Outcomes From the Electronic Health Record Following Critical Illness in the Elderly.

作者信息

Ahmad Sumera R, Tarabochia Alex D, Budahn Luann, Lemahieu Allison M, Anderson Brenda, Vashistha Kirtivardhan, Karnatovskaia Lioudmila, Gajic Ognjen

机构信息

Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States.

Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.

出版信息

Front Med (Lausanne). 2022 Jun 6;9:826169. doi: 10.3389/fmed.2022.826169. eCollection 2022.


DOI:10.3389/fmed.2022.826169
PMID:35733861
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9207323/
Abstract

BACKGROUND: Meaningful patient centered outcomes of critical illness such as functional status, cognition and mental health are studied using validated measurement tools that may often be impractical outside the research setting. The Electronic health record (EHR) contains a plethora of information pertaining to these domains. We sought to determine how feasible and reliable it is to assess meaningful patient centered outcomes from the EHR. METHODS: Two independent investigators reviewed EHR of a random sample of ICU patients looking at documented assessments of trajectory of functional status, cognition, and mental health. Cohen's kappa was used to measure agreement between 2 reviewers. Post ICU health in these domains 12 month after admission was compared to pre- ICU health in the 12 months prior to assess qualitatively whether a patient's condition was "better," "unchanged" or "worse." Days alive and out of hospital/health care facility was a secondary outcome. RESULTS: Thirty six of the 41 randomly selected patients (88%) survived critical illness. EHR contained sufficient information to determine the difference in health status before and after critical illness in most survivors (86%). Decline in functional status (36%), cognition (11%), and mental health (11%) following ICU admission was observed compared to premorbid baseline. Agreement between reviewers was excellent (kappa ranging from 0.966 to 1). Eighteen patients (44%) remained home after discharge from hospital and rehabilitation during the 12- month follow up. CONCLUSION: We demonstrated the feasibility and reliability of assessing the trajectory of changes in functional status, cognition, and selected mental health outcomes from EHR of critically ill patients. If validated in a larger, representative sample, these outcomes could be used alongside survival in quality improvement studies and pragmatic clinical trials.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3ff/9207323/b0bb2d018330/fmed-09-826169-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3ff/9207323/b0bb2d018330/fmed-09-826169-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3ff/9207323/b0bb2d018330/fmed-09-826169-g0001.jpg

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本文引用的文献

[1]
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Acta Anaesthesiol Scand. 2022-1

[2]
Days alive and at home after hip fracture: a cross-sectional validation of a patient-centred outcome measure using routinely collected data.

BMJ Qual Saf. 2023-9

[3]
Hospital-Free Days: A Pragmatic and Patient-centered Outcome for Trials among Critically and Seriously Ill Patients.

Am J Respir Crit Care Med. 2021-10-15

[4]
Mapping the Presence of Anxiety Symptoms in Adults With Major Depressive Disorder.

Front Psychiatry. 2021-5-19

[5]
Machine Learning and Natural Language Processing in Mental Health: Systematic Review.

J Med Internet Res. 2021-5-4

[6]
Detection of Cognitive Impairment after Critical Illness with the Medicare Annual Wellness Visit: A Cohort Study.

Ann Am Thorac Soc. 2021-10

[7]
Early and sustained Lactobacillus plantarum probiotic therapy in critical illness: the randomised, placebo-controlled, restoration of gut microflora in critical illness trial (ROCIT).

Intensive Care Med. 2021-3

[8]
Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study.

Lancet Public Health. 2021-2

[9]
Predictors of Functional Dependence After COVID-19: A Retrospective Examination Among Veterans.

Am J Phys Med Rehabil. 2021-1-1

[10]
Provider-Documented Anxiety in the ICU: Prevalence, Risk Factors, and Associated Patient Outcomes.

J Intensive Care Med. 2021-12

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