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dc.contributor.authorEssay, Patrick
dc.contributor.authorMosier, Jarrod
dc.contributor.authorSubbian, Vignesh
dc.date.accessioned2020-11-07T01:33:43Z
dc.date.available2020-11-07T01:33:43Z
dc.date.issued2020-04-15
dc.identifier.citationMosier, J., & Subbian, V. (2020). Rule-Based Cohort Definitions for Acute Respiratory Failure: Electronic Phenotyping Algorithm. JMIR Medical Informatics, 8(4), e18402.en_US
dc.identifier.issn2291-9694
dc.identifier.pmid32293579
dc.identifier.doi10.2196/18402
dc.identifier.urihttp://hdl.handle.net/10150/648138
dc.description.abstractBackground: Acute respiratory failure is generally treated with invasive mechanical ventilation or noninvasive respiratory support strategies. The efficacies of the various strategies are not fully understood. There is a need for accurate therapy-based phenotyping for secondary analyses of electronic health record data to answer research questions regarding respiratory management and outcomes with each strategy. Objective: The objective of this study was to address knowledge gaps related to ventilation therapy strategies across diverse patient populations by developing an algorithm for accurate identification of patients with acute respiratory failure. To accomplish this objective, our goal was to develop rule-based computable phenotypes for patients with acute respiratory failure using remotely monitored intensive care unit (tele-ICU) data. This approach permits analyses by ventilation strategy across broad patient populations of interest with the ability to sub-phenotype as research questions require. Methods: Tele-ICU data from >= 200 hospitals were used to create a rule based algorithm for phenotyping patients with acute respiratory failure, defined as an adult patient requiring invasive mechanical ventilation or a noninvasive strategy. The dataset spans a wide range of hospitals and ICU types across all US regions. Structured clinical data, including ventilation therapy start and stop times, medication records, and nurse and respiratory therapy charts, were used to define clinical phenotypes. All adult patients of any diagnoses with record of ventilation therapy were included. Patients were categorized by ventilation type, and analysis of event sequences using record timestamps defined each phenotype. Manual validation was performed on 5% of patients in each phenotype. Results: We developed 7 phenotypes: (0) invasive mechanical ventilation, (1) noninvasive positive-pressure ventilation, (2) high-flow nasal insufflation, (3) noninvasive positive-pressure ventilation subsequently requiring intubation, (4) high-flow nasal insufflation subsequently requiring intubation, (5) invasive mechanical ventilation with extubation to noninvasive positive-pressure ventilation, and (6) invasive mechanical ventilation with extubation to high-flow nasal insufflation. A total of 27,734 patients met our phenotype criteria and were categorized into these ventilation subgroups. Manual validation of a random selection of 5% of records from each phenotype resulted in a total accuracy of 88% and a precision and recall of 0.8789 and 0.8785, respectively, across all phenotypes. Individual phenotype validation showed that the algorithm categorizes patients particularly well but has challenges with patients that require >= 2 management strategies. Conclusions: Our proposed computable phenotyping algorithm for patients with acute respiratory failure effectively identifies patients for therapy-focused research regardless of admission diagnosis or comorbidities and allows for management strategy comparisons across populations of interest.en_US
dc.language.isoenen_US
dc.publisherJMIR PUBLICATIONS, INCen_US
dc.rights© Patrick Essay, Jarrod Mosier, Vignesh Subbian. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 15.04.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/).en_US
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en_US
dc.subjectcomputable phenotypeen_US
dc.subjectelectronic health recorden_US
dc.subjectintensive care unitsen_US
dc.subjectcritical care informaticsen_US
dc.subjecttelemedicineen_US
dc.subjectrespiratoryen_US
dc.titleRule-Based Cohort Definitions for Acute Respiratory Failure: Electronic Phenotyping Algorithmen_US
dc.typeArticleen_US
dc.contributor.departmentUniv Arizona, Coll Engnen_US
dc.contributor.departmentUniv Arizona, Coll Meden_US
dc.identifier.journalJMIR MEDICAL INFORMATIONSen_US
dc.description.noteOpen access journalen_US
dc.description.collectioninformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.en_US
dc.eprint.versionFinal published versionen_US
dc.source.journaltitleJMIR medical informatics
dc.source.volume8
dc.source.issue4
dc.source.beginpagee18402
dc.source.endpage
refterms.dateFOA2020-11-07T01:33:56Z
dc.source.countryUnited States
dc.source.countryCanada


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© Patrick Essay, Jarrod Mosier, Vignesh Subbian. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 15.04.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/).
Except where otherwise noted, this item's license is described as © Patrick Essay, Jarrod Mosier, Vignesh Subbian. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 15.04.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/).