CC BY 4.0 · Indian J Med Paediatr Oncol
DOI: 10.1055/s-0043-1776357
Perspective

Enhancing Hospitalized Patients' Palliative Care Referrals via Machine Learning-Based Predictive Modeling within Electronic Health Record Systems

1   Princess Margaret Cancer Centre, Toronto, Canada
› Author Affiliations

Abstract

Access to palliative care (PC) holds significance for hospital-admitted patients grappling with the symptoms of life limiting illnesses. Nonetheless, numerous such patients who could gain from PC fail to receive it promptly or even at all.

We can leverage the prior year's historical data extracted from electronic health records of hospitalized patients to train a machine learning (ML) model. This model's purpose would be to prognosticate the requirement for PC consultation using real-time data. The model, operating as a semi-supervised system, will be integrated into institutional data pipelines, and utilized by a downstream display application overseen by the PC team. In cases where the PC team deems it suitable, a team member will communicate with the respective care team of the patient. The ML model's training efficacy will be assessed using the area under the curve (AUC) metric, employing a 20% reserved validation set. The threshold for PC consultations will be grounded in historical data. To enhance the ML model's precision, the pivotal variables within the model will be pinpointed, and any sources of biases or errors in the model will be identified for meticulous refinement. The AUC values of successive ML models will be juxtaposed with cross-validation data.

Automatizing the referral procedure through electronic health record systems has the potential to usher in a more effective and streamlined approach to healthcare delivery.

Patient Consent

None Declared.


Disclosure of Funding Support

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.




Publication History

Article published online:
22 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Palliative care. Accessed October 8, 2023 at: https://www.who.int/news-room/fact-sheets/detail/palliative-care
  • 2 Ghosheh GO, Thwaites CL, Zhu T, Thwaites CL, Zhu T. Synthesizing electronic health records for predictive models in low-middle-income countries (LMICs). Biomedicines 2023; 11 (06) 1749
  • 3 Barry C, Paes P, Noble S, Davies A. Challenges to delivering evidence-based palliative medicine. Clin Med (Lond) 2023; 23 (02) 182-184
  • 4 Preisler M, Rohrmoser A, Bar K, Letsch A, Goerling U. Early integration of palliative/supportive cancer care-healthcare professionals' perspectives on the support needs of cancer patients and their caregivers across the cancer treatment trajectory. Oncol Res Treat 2017; 40 (Suppl. 03) 187
  • 5 Grant M, Elk R, Ferrell B, Morrison RS, von Gunten CF. Current status of palliative care–clinical implementation, education, and research. CA Cancer J Clin 2009; 59 (05) 327-335
  • 6 Kristjanson LJ, Aoun SM, Oldham L. Palliative care and support for people with neurodegenerative conditions and their carers. Int J Palliat Nurs 2006; 12 (08) 368-377
  • 7 Radbruch L, De Lima L, Knaul F. et al. Redefining palliative care-a new consensus-based definition. J Pain Symptom Manage 2020; 60 (04) 754-764
  • 8 Ramasamy Venkatasalu M, Sirala Jagadeesh N, Elavally S, Pappas Y, Mhlanga F, Pallipalayam Varatharajan R. Public, patient and carers' views on palliative and end-of-life care in India. Int Nurs Rev 2018; 65 (02) 292-301
  • 9 Stiel S, Pastrana T, Balzer C, Elsner F, Ostgathe C, Radbruch L. Outcome assessment instruments in palliative and hospice care–a review of the literature. Support Care Cancer 2012; 20 (11) 2879-2893
  • 10 May P, Garrido MM, Cassel JB. et al. Cost analysis of a prospective multi-site cohort study of palliative care consultation teams for adults with advanced cancer: where do cost-savings come from?. Palliat Med 2017; 31 (04) 378-386
  • 11 Morrison RS, Penrod JD, Cassel JB. et al; Palliative Care Leadership Centers' Outcomes Group. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med 2008; 168 (16) 1783-1790
  • 12 Michalko M. Thinkertoys: a handbook of creative-thinking techniques.:355. Accessed October 8, 2023 at: https://books.google.com/books/about/Thinkertoys.html?id=y7O_6v1c52wC
  • 13 Kohavi R, Longbotham R. Online Controlled Experiments and A/B Tests. Encyclopedia of Machine Learning and Data Science. Published online 2023:1–13 DOI: 10.1007/978-1-4899-7502-7_891-2
  • 14 Health Information Systems: Concepts, Methodologies, Tools, and Applications ... - Google Books. Accessed October 8, 2023 at: https://books.google.ca/books?id=WnBJsRtfVbYC&pg=PR39&redir_esc=y#v=onepage&q&f=false
  • 15 Novak PK, Lavrač N, Webb GI. Supervised descriptive rule induction. Encyclopedia of Machine Learning and Data Mining 2016; 1-4
  • 16 Natekin A, Knoll A. Gradient boosting machines, a tutorial. Front Neurorobot 2013; 7 (DEC): 21
  • 17 Software as a Medical Device (SaMD) | FDA. Accessed October 8, 2023 at: https://www.fda.gov/medical-devices/digital-health-center-excellence/software-medical-device-samd