Williams Kelly, Nikolajski Cara, Rodriguez Samantha, Kwok Elaine, Gopalan Priya, Simhan Hyagriv, Krishnamurti Tamar
UPMC Center for High-Value Health Care, Pittsburgh, PA 15219, United States.
Department of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States.
J Am Med Inform Assoc. 2025 Jul 1;32(7):1186-1198. doi: 10.1093/jamia/ocaf086.
Machine learning algorithms can advance clinical care, including identifying mental health conditions. These algorithms are often developed without considering the perspectives of the affected populations. This study describes the process of incorporating end-user perspectives into the development and implementation planning of a prediction algorithm for new perinatal depression onset.
A focus group (N = 12 providers) and four virtual community engagement studios (N = 21 patients) were conducted. The project team presented on the initial development of a novel prediction algorithm used to detect first time perinatal depression. Rapid qualitative analysis coded the prediction algorithm's completeness, interpretability, and acceptability to stakeholders, with the goal of informing clinical implementation of a patient-facing screener produced from the prediction algorithm.
Providers and patients showed consensus on the interpretability of the prediction algorithm's variables and discussed additional variables believed to be predictive of depression to ensure its completeness. In terms of acceptability, patients expressed a desire to discuss predictive risk screening results with their provider, while providers voiced concerns about limited bandwidth for these discussions. Both groups identified the need for post-screening resource connection but raised concerns over the availability of depression prevention specific resources. Providers and patients reported positively about their engagement in the sessions.
Qualitative findings were incorporated into iterative algorithm development and informed an implementation pilot plan.
This study demonstrates how the expertise of the end-users of a risk prediction algorithm can be incorporated into its development, which may ultimately increase clinical adoption.
机器学习算法可推动临床护理发展,包括识别心理健康状况。这些算法的开发往往未考虑受影响人群的观点。本研究描述了将最终用户观点纳入围产期新发抑郁症预测算法开发及实施规划过程的情况。
开展了一次焦点小组讨论(12名提供者)和四个虚拟社区参与工作室活动(21名患者)。项目团队介绍了用于检测首次围产期抑郁症的新型预测算法的初步开发情况。快速定性分析对预测算法对利益相关者的完整性、可解释性和可接受性进行编码,目的是为基于该预测算法生成的面向患者的筛查工具的临床实施提供信息。
提供者和患者对预测算法变量的可解释性达成共识,并讨论了其他被认为可预测抑郁症的变量,以确保其完整性。在可接受性方面,患者表示希望与提供者讨论预测风险筛查结果,而提供者则对这些讨论的时间有限表示担忧。两组都确定了筛查后资源连接的必要性,但对预防抑郁症特定资源的可用性表示担忧。提供者和患者对参与这些活动给予了积极评价。
定性研究结果被纳入算法的迭代开发,并为实施试点计划提供了参考。
本研究展示了如何将风险预测算法最终用户的专业知识纳入其开发过程,这可能最终提高临床应用率。