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Nurses' documentation of patient diagnoses, symptoms and interventions for home care patients with Alzheimer's Disease and related dementias: A natural language processing study

Award Number: R21AG065753
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/01/2020
PERIOD OF PERFORMANCE END DATE: 11/30/2022

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Nurses' documentation of patient diagnoses, symptoms and interventions for home care patients with Alzheimer's Disease and related dementias: A natural language processing study - PROJECT SUMMARY Alzheimer's disease and related dementias (ADRD) represent a looming public health crisis, affecting roughly 5 million people and 11% of older adults in the United States. Studies on patient transitions across healthcare settings suggests that older adults with chronic conditions are vulnerable to inadequate transfer of information, putting them at risk for diminished quality of care, medication errors and potentially preventable complications. Patients at varied stages along the ADRD trajectory – especially those with multiple chronic conditions – may experience unique risks due to the loss of information across care settings. In a recent study, we developed a longitudinal dataset on a diverse cohort of 56,652 patients – mostly aged 65+ with multiple comorbidities – receiving home health care (HHC) services from a large non-profit home care provider. For patients admitted to HHC in 2010-2012, we identified subgroups of patients with ADRD diagnoses made prior to and after HHC admission. Outside the scope of this prior study remains a vast and largely unexplored data source – nurses’ free-text clinical notes captured in the electronic health record. With roughly 1 million entries of nurses’ free- text notes associated with the study population, there is a wealth of potential information from which to gain new insights and a need for innovative methods to analyze this unstructured data source. In this study, we propose to use natural language processing (NLP) techniques, a method for systematically analyzing free-text content that draws upon machine learning. Using the dataset developed in the prior study, this study aims to: 1. Expand and improve an existing NLP system to automatically identify the following information in the nursing free-text notes: (i) knowledge of the patient having a previously established ADRD diagnosis; (ii) observations of cognitive symptoms and related patient/caregiver needs; and (iii) mentions of interventions to address these needs. 2. For patients who do not have an ADRD diagnosis prior to HHC admission, determine whether nurses’ free- text documentation of cognitive symptoms identified in the NLP predict subsequent ADRD diagnoses during the 4-year follow-up period. 3. Among patients diagnosed with ADRD prior to HHC admission, determine whether nurses’ free-text documentation patterns (e.g. knowledge of the patient’s ADRD diagnostic status, observations of cognitive symptoms, and interventions) predict: (i) service use; and (ii) adverse health outcomes for which ADRD patients are at heightened risk (e.g. hospitalizations due to urinary tract infection, dehydration, falls). This study will allow us to examine HHC nurses’ practices, which are often difficult to observe systematically, and identify strategies to address the complex needs of their patients with ADRD and un-diagnosed patients who may be on a path toward ADRD diagnosis. The long-term goal of this research is to develop a home- based intervention that aims to improve quality of life for patients and caregivers along the ADRD trajectory.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $0 )
2024	2021	VISITING NURSE SERVICE OF NEW YORK	220 E 42ND ST FL 6	NEW YORK	NY	10017	NEW YORK	USA	Aging Research	000	2	12/8/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2021 ( Subtotal = $213,501 )
2021	2021	VISITING NURSE SERVICE OF NEW YORK	220 E 42ND ST FL 6	NEW YORK	NY	10017	NEW YORK	USA	Aging Research	000	2	5/18/2021	NON-COMPETING CONTINUATION	$213,501
														Subtotal = $213,501

Issue Date FY: 2020 ( Subtotal = $260,660 )
2020	2020	VISITING NURSE SERVICE OF NEW YORK	220 E 42ND ST FL 6	NEW YORK	NY	10017	NEW YORK	USA	Aging Research	000	1	7/20/2020	NEW	$260,660
														Subtotal = $260,660

Grand Total All Awards = $474,161

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Nurses' documentation of patient diagnoses, symptoms and interventions for home care patients with Alzheimer's Disease and related dementias: A natural language processing study

Award Number: R21AG065753

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 08/01/2020

PERIOD OF PERFORMANCE END DATE: 11/30/2022

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