Documentation of Shared Decisionmaking in the Emergency Department - 20/10/21
Abstract |
Study objective |
While patient-centered communication and shared decisionmaking are increasingly recognized as vital aspects of clinical practice, little is known about their characteristics in real-world emergency department (ED) settings. We constructed a natural language processing tool to identify patient-centered communication as documented in ED notes and to describe visit-level, site-level, and temporal patterns within a large health system.
Methods |
This was a 2-part study involving (1) the development and validation of an natural language processing tool using regular expressions to identify shared decisionmaking and (2) a retrospective analysis using mixed effects logistic regression and trend analysis of shared decisionmaking and general patient discussion using the natural language processing tool to assess ED physician and advanced practice provider notes from 2013 to 2020.
Results |
Compared to chart review of 600 ED notes, the accuracy rates of the natural language processing tool for identification of shared decisionmaking and general patient discussion were 96.7% (95% CI 94.9% to 97.9%) and 88.9% (95% confidence interval [CI] 86.1% to 91.3%), respectively. The natural language processing tool identified shared decisionmaking in 58,246 (2.2%) and general patient discussion in 590,933 (22%) notes. From 2013 to 2020, natural language processing-detected shared decisionmaking increased 300% and general patient discussion increased 50%. We observed higher odds of shared decisionmaking documentation among physicians versus advanced practice providers (odds ratio [OR] 1.14, 95% CI 1.07 to 1.23) and among female versus male patients (OR 1.13, 95% CI 1.11 to 1.15). Black patients had lower odds of shared decisionmaking (OR 0.8, 95% CI 0.84 to 0.88) compared with White patients. Shared decisionmaking and general patient discussion were also associated with higher levels of triage and commercial insurance status.
Conclusion |
In this study, we developed and validated an natural language processing tool using regular expressions to extract shared decisionmaking from ED notes and found multiple potential factors contributing to variation, including social, demographic, temporal, and presentation characteristics.
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| Please see page 638 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Stephen Schenkel, MD, MPP. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: DC and RAT conceived the study and designed its methods. DC, RAT, and JT obtained the data and performed the analysis. DC and RAT drafted the manuscript, and MS, BE, RF, JT, ES, and CB contributed substantially to its revision. RAT takes responsibility for the paper as a whole. |
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| Authorship: All authors attest to meeting the 4 ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. The authors report this article did not receive any outside funding or support. |
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| Trial registration number: N/A. |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 78 - N° 5
P. 637-649 - novembre 2021 Retour au numéro
Article précédent
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- Cadence F. Bowden, Gala True, Sara Wiesel Cullen, Miranda Pollock, Diana Worsley, Abigail M. Ross, Jeffrey Caterino, Mark Olfson, Steven C. Marcus, Stephanie K. Doupnik
- The Influence of the Availability Heuristic on Physicians in the Emergency Department
- Dan P. Ly
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