Development and validation of the early warning system scores ontology.

BACKGROUND: Clinical early warning scoring systems, have improved patient outcomes in a range of specializations and global contexts. These systems are used to predict patient deterioration. A multitude of patient-level physiological decompensation data has been made available through the widespread integration of early warning scoring systems within EHRs across national and international health care organizations. These data can be used to promote secondary research. The diversity of early warning scoring systems and various EHR systems is one barrier to secondary analysis of early warning score data. Given that early warning score parameters are varied, this makes it difficult to query across providers and EHR systems. Moreover, mapping and merging the parameters is challenging. We develop and validate the Early Warning System Scores Ontology (EWSSO), representing three commonly used early warning scores: the National Early Warning Score (NEWS), the six-item modified Early Warning Score (MEWS), and the quick Sequential Organ Failure Assessment (qSOFA) to overcome these problems. METHODS: We apply the Software Development Lifecycle Framework-conceived by Winston Boyce in 1970-to model the activities involved in organizing, producing, and evaluating the EWSSO. We also follow OBO Foundry Principles and the principles of best practice for domain ontology design, terms, definitions, and classifications to meet BFO requirements for ontology building. RESULTS: We developed twenty-nine new classes, reused four classes and four object properties to create the EWSSO. When we queried the data our ontology-based process could differentiate between necessary and unnecessary features for score calculation 100% of the time. Further, our process applied the proper temperature conversions for the early warning score calculator 100% of the time. CONCLUSIONS: Using synthetic datasets, we demonstrate the EWSSO can be used to generate and query health system data on vital signs and provide input to calculate the NEWS, six-item MEWS, and qSOFA. Future work includes extending the EWSSO by introducing additional early warning scores for adult and pediatric patient populations and creating patient profiles that contain clinical, demographic, and outcomes data regarding the patient.

Experiences with developing and implementing a courageous conversations pilot classroom through synchronous meetings via zoom.

Background: The murder of George Floyd created national outcry that echoed down to national institutions, including universities and academic systems to take a hard look at systematic and systemic racism in higher education. This motivated the creation of a fear and tension-minimizing, curricular offering, "Courageous Conversations," collaboratively engaging students, staff, and faculty in matters of diversity, equity, and inclusion (DEI) in the Department of Health Outcomes and Biomedical Informatics at the University of Florida. Methods: A qualitative design was employed assessing narrative feedback from participants during the Fall semester of 2020. Additionally, the ten-factor model implementation framework was applied and assessed. Data collection included two focus groups and document analysis with member-checking. Thematic analysis (i.e., organizing, coding, synthesizing) was used to analyze a priori themes based on the four agreements of the courageous conversations framework, stay engaged, expect to experience discomfort, speak your truth, and expect and accept non-closure. Results: A total of 41 participants of which 20 (48.78%) were department staff members, 11 (26.83%) were department faculty members, and 10 (24.30%) were graduate students. The thematic analysis revealed 1) that many participants credited their learning experiences to what their peers had said about their own personal lived experiences during group sessions, and 2) several participants said they would either retake the course or recommend it to a colleague. Conclusion: With structured implementation, courageous conversations can be an effective approach to create more diverse, equitable, and inclusive spaces in training programs with similar DEI ecosystems.

Repeatable enhancement of healthcare data with social determinants of health.

Background: Social and behavioral aspects of our lives significantly impact our health, yet minimal social determinants of health (SDOH) data elements are collected in the healthcare system. Methods: In this proof-of-concept study we developed a repeatable SDOH enrichment and integration process to incorporate dynamically evolving SDOH domain concepts from consumers into clinical data. This process included SDOH mapping, linking compiled consumer data to patient records in Electronic Health Records, data quality analysis and preprocessing, and storage. Results: Consumer compilers data coverage ranged from ~90 to ~54% and the percentage match rate between compilers was between ~21 and 64%. Our preliminary analysis showed that apart from demographic factors, several SDOH factors like home-ownership, marital-status, presence of children, number of members per household, economic stability and education were significantly different between the COVID-19 positive and negative patient groups while estimated family-income and home market-value were not. Conclusion: Our preliminary analysis shows commercial consumer data can be a viable source of SDOH factor at an individual-level for clinical data thus providing a path for clinicians to improve patient treatment and care.

Assessing the Need for Semantic Data Integration for Surgical Biobanks-A Knowledge Representation Perspective.

To improve patient outcomes after trauma, the need to decrypt the post-traumatic immune response has been identified. One prerequisite to drive advancement in understanding that domain is the implementation of surgical biobanks. This paper focuses on the outcomes of patients with one of two diagnoses: post-traumatic arthritis and osteomyelitis. In creating surgical biobanks, currently, many obstacles must be overcome. Roadblocks exist around scoping of data that is to be collected, and the semantic integration of these data. In this paper, the generic component model and the Semantic Web technology stack are used to solve issues related to data integration. The results are twofold: (a) a scoping analysis of data and the ontologies required to harmonize and integrate it, and (b) resolution of common data integration issues in integrating data relevant to trauma surgery.

Examining Healthcare Utilization Patterns of Elderly Middle-Aged Adults in the United States.

Elderly patients, aged 65 or older, make up 13.5% of the U.S. population, but represent 45.2% of the top 10% of healthcare utilizers, in terms of expenditures. Middle-aged Americans, aged 45 to 64 make up another 37.0% of that category. Given the high demand for healthcare services by the aforementioned population, it is important to identify high-cost users of healthcare systems and, more importantly, ineffective utilization patterns to highlight where targeted interventions could be placed to improve care delivery. In this work, we present a novel multi-level framework applying machine learning (ML) methods (i.e., random forest regression and hierarchical clustering) to group patients with similar utilization profiles into clusters. We use a vector space model to characterize a patient's utilization profile as the number of visits to different care providers and prescribed medications. We applied the proposed methods using the 2013 Medical Expenditures Panel Survey (MEPS) dataset. We identified clusters of healthcare utilization patterns of elderly and middle-aged adults in the United States, and assessed the general and clinical characteristics associated with these utilization patterns. Our results demonstrate the effectiveness of the proposed framework to model healthcare utilization patterns. Understanding of these patterns can be used to guide healthcare policy-making and practice.

Prevalence of prediabetes in England from 2003 to 2011: population-based, cross-sectional study.

OBJECTIVE: Prediabetes is a high-risk state for developing diabetes and associated complications. The purpose of this paper was to report trends in prevalence of prediabetes for individuals aged 16 and older in England without previously diagnosed diabetes. SETTING: Data collected by the Health Survey for England (HSE) in England in the years 2003, 2006, 2009 and 2011. PARTICIPANTS: Individuals aged 16 and older who participated in the HSE and provided a blood sample. PRIMARY OUTCOME VARIABLE: Individuals were classified as having prediabetes if glycated haemoglobin was between 5.7% and 6.4% and were not previously diagnosed with diabetes. RESULTS: The prevalence rate of prediabetes increased from 11.6% to 35.3% from 2003 to 2011. By 2011, 50.6% of the population who were overweight (body mass index (BMI)>25) and ≥40 years of age had prediabetes. In bivariate relationships, individuals with greater socioeconomic deprivation were more likely to have prediabetes in 2003 (p=0.0008) and 2006 (p=0.0246), but the relationship was not significant in 2009 (p=0.213) and 2011 (p=0.3153). In logistic regressions controlling for age, sex, race/ethnicity, BMI and high blood pressure, the second most socioeconomically deprived had a significantly elevated risk of having prediabetes (2011, OR=1.45; 95% CI 1.26 to 1.88). CONCLUSIONS: There has been a marked increase in the proportion of adults in England with prediabetes. The socioeconomically deprived are at substantial risk. In the absence of concerted and effective efforts to reduce risk, the number of people with diabetes is likely to increase steeply in coming years.