A Data-Driven Algorithm to Recommend Initial Clinical Workup for Outpatient Specialty Referral: Algorithm Development and Validation Using Electronic Health Record Data and Expert Surveys
Autor: | Wui Ip, Priya Prahalad, Jonathan Palma, Jonathan H Chen |
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Jazyk: | angličtina |
Rok vydání: | 2022 |
Předmět: | |
Zdroj: | JMIR Medical Informatics, Vol 10, Iss 3, p e30104 (2022) |
Druh dokumentu: | article |
ISSN: | 2291-9694 |
DOI: | 10.2196/30104 |
Popis: | BackgroundMillions of people have limited access to specialty care. The problem is exacerbated by ineffective specialty visits due to incomplete prereferral workup, leading to delays in diagnosis and treatment. Existing processes to guide prereferral diagnostic workup are labor-intensive (ie, building a consensus guideline between primary care doctors and specialists) and require the availability of the specialists (ie, electronic consultation). ObjectiveUsing pediatric endocrinology as an example, we develop a recommender algorithm to anticipate patients’ initial workup needs at the time of specialty referral and compare it to a reference benchmark using the most common workup orders. We also evaluate the clinical appropriateness of the algorithm recommendations. MethodsElectronic health record data were extracted from 3424 pediatric patients with new outpatient endocrinology referrals at an academic institution from 2015 to 2020. Using item co-occurrence statistics, we predicted the initial workup orders that would be entered by specialists and assessed the recommender’s performance in a holdout data set based on what the specialists actually ordered. We surveyed endocrinologists to assess the clinical appropriateness of the predicted orders and to understand the initial workup process. ResultsSpecialists (n=12) indicated that |
Databáze: | Directory of Open Access Journals |
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