Silver School of Social Work, New York University, 1 Washington Square N, New York, NY, 10003, United States, 1 3016931203.
Graduate School of Service, Fordham University, New York, NY, United States.
JMIR Med Inform. 2024 Sep 20;12:e52678. doi: 10.2196/52678.
Collaborative documentation (CD) is a behavioral health practice involving shared writing of clinic visit notes by providers and consumers. Despite widespread dissemination of CD, research on its effectiveness or impact on person-centered care (PCC) has been limited. Principles of PCC planning, a recovery-based approach to service planning that operationalizes PCC, can inform the measurement of person-centeredness within clinical documentation.
This study aims to use the clinical informatics approach of natural language processing (NLP) to examine the impact of CD on person-centeredness in clinic visit notes. Using a dictionary-based approach, this study conducts a textual analysis of clinic notes from a community mental health center before and after staff were trained in CD.
This study used visit notes (n=1981) from 10 providers in a community mental health center 6 months before and after training in CD. LIWC-22 was used to assess all notes using the Linguistic Inquiry and Word Count (LIWC) dictionary, which categorizes over 5000 linguistic and psychological words. Twelve LIWC categories were selected and mapped onto PCC planning principles through the consensus of 3 domain experts. The LIWC-22 contextualizer was used to extract sentence fragments from notes corresponding to LIWC categories. Then, fixed-effects modeling was used to identify differences in notes before and after CD training while accounting for nesting within the provider.
Sentence fragments identified by the contextualizing process illustrated how visit notes demonstrated PCC. The fixed effects analysis found a significant positive shift toward person-centeredness; this was observed in 6 of the selected LIWC categories post CD. Specifically, there was a notable increase in words associated with achievement (β=.774, P<.001), power (β=.831, P<.001), money (β=.204, P<.001), physical health (β=.427, P=.03), while leisure words decreased (β=-.166, P=.002).
By using a dictionary-based approach, the study identified how CD might influence the integration of PCC principles within clinical notes. Although the results were mixed, the findings highlight the potential effectiveness of CD in enhancing person-centeredness in clinic notes. By leveraging NLP techniques, this research illuminated the value of narrative clinical notes in assessing the quality of care in behavioral health contexts. These findings underscore the promise of NLP for quality assurance in health care settings and emphasize the need for refining algorithms to more accurately measure PCC.
协作式文档记录（CD）是一种行为健康实践，涉及提供者和消费者共同撰写临床就诊记录。尽管 CD 已广泛传播，但关于其有效性或对以患者为中心的护理（PCC）的影响的研究却很有限。PCC 规划原则，即一种基于恢复的服务规划方法，可将 PCC 付诸实践，可以为临床文档中以患者为中心的程度的衡量提供信息。
本研究旨在使用自然语言处理（NLP）的临床信息学方法，检查 CD 对就诊记录中以患者为中心程度的影响。该研究使用基于字典的方法，对接受 CD 培训前后 10 名提供者的社区心理健康中心的就诊记录进行了文本分析。使用语言调查与词频（LIWC）字典评估了所有记录，LIWC 字典对 5000 多个语言和心理词汇进行了分类。选择了 12 个 LIWC 类别，并通过 3 位领域专家的共识映射到 PCC 规划原则。使用 LIWC-22 上下文生成器从与 LIWC 类别对应的记录中提取句子片段。然后，使用固定效应模型在考虑提供者内部嵌套的情况下，识别 CD 培训前后记录中的差异。
通过上下文生成过程确定的句子片段说明了就诊记录如何体现 PCC。固定效应分析发现，向以患者为中心的方向发生了显著的积极转变；在接受 CD 培训后，这在 6 个选定的 LIWC 类别中表现出来。具体而言，与成就相关的词汇显著增加（β=.774，P<.001），权力（β=.831，P<.001），金钱（β=.204，P<.001），身体健康（β=.427，P=.03），而休闲词汇减少（β=-.166，P=.002）。
通过使用基于字典的方法，本研究确定了 CD 如何影响 PCC 原则在临床记录中的整合。尽管结果喜忧参半，但这些发现突出了 CD 在增强临床记录中以患者为中心程度方面的潜在有效性。通过利用 NLP 技术，本研究阐明了叙事临床记录在评估行为健康背景下护理质量方面的价值。这些发现强调了 NLP 在医疗保健环境中进行质量保证的潜力，并强调需要改进算法以更准确地衡量 PCC。
