临床知情的机器学习阐明了医院内的临终关怀种族差异的形状
Inas S Khayal1,2,3,4, A James O'Malley5,6,7,8, Amber E Barnato5,9,10
1The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, 03756, USA. inas.khayal@dartmouth.edu.
NPJ digital medicine
|October 12, 2023
概括
临终关怀中的种族差异是复杂的. 机器学习揭示了种族群体之间住院利用的不同模式,显示当前的质量指标掩盖了癌症护理的真正差异.
科学领域:
- 医疗保健差异研究 医疗保健差异研究
- 在瘤学中的数据科学.
- 机器学习在公共卫生中的应用.
背景情况:
- 在癌症患者的宿舍护理中存在种族差异是有记录的,但发现是矛盾的.
- 现有的质量指标汇总数据,掩盖了对医疗保健公平的可操作见解.
- 需要先进的方法来理解和解决这些差异.
研究的目的:
- 开发一种可解释的机器学习方法,以阐明宿舍护理中的医疗保健差异.
- 提供超越传统指标的更可操作的质量改进信息.
- 识别和描述临终关怀利用中的种族差异特征.
主要方法:
- 利用了美国医疗保险 (Medicare) 对晚期癌症患者 (去世于2016年4月至12月) 的宿舍利用数据.
- 在每个医院,每个患者组开发了按使用时间的配置文件,整合了临床信息和系统建模.
- 计算了有色人种和白人患者的个人资料之间的差异,以确定种族差异签名,然后使用机器学习对这些签名进行集群.
主要成果:
- 分析了来自362家医院的45125名患者的数据,确定了7个不同的种族差异签名集群.
- 四个集群 (190家医院) 显示有色人种更高的住院利用率;两个集群 (106家医院) 显示白人更高的住院利用率.
- 一个集群 (66家医院) 在组间利用率上没有显著差异.
- 医院内部的差异模式无法通过标准的质量指标来预测.
结论:
- 对宿舍使用数据的算法分析揭示了以前被综合质量指标所掩盖的复杂的种族差异形状.
- 机器学习提供了对差异的更细致的理解,突出了当前质量指标的局限性.
- 这种方法提供了一种途径,以确定可操作的见解,以改善癌症患者的宿舍护理公平性.
相关概念视频
Ethical Issues
996
Nurses are essential in patient care, upholding the ethical principles of their profession and effectively navigating ethical dilemmas. Neglecting ethical issues can lead to inadequate patient care, compromised therapeutic relationships, and moral distress among healthcare workers.
Ethical Concerns in Healthcare:
Ethical Concerns in Healthcare:
996
Documentation in Long-Term and Home Healthcare Setting
900
Documentation in long-term care facilities and home healthcare settings is crucial for ensuring continuous, coordinated, and comprehensive care for patients. Each setting has its specific documentation processes and tools:
Long-Term Care Facilities
Long-Term Care Facilities
900
Continuing Care
1.5K
Continuing care describes the variety of health, personal, and social services provided over a prolonged period. The need for continuing care is increasing because people are living longer. Many people do not have families or others to care for them. Continuing care is mainly for patients who are disabled, functionally dependent, or suffering from a terminal disease. It is available within institutional settings or in homes. Examples include nursing centers or facilities, assisted living,...
1.5K
Nursing Ethical Principles II
1.0K
Ethical principles are essential in guiding nurses to fulfill their responsibilities, focusing on the quality of nursing care and decision-making. These principles, including autonomy, beneficence, non-maleficence, justice, and fidelity, shape the ethical framework within healthcare settings.
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...
1.0K
Patient-centered Care
2.1K
Patient-centered care involves delivering care beyond inpatient hospitalization. Reflective practice can enhance a patient-centered approach. Reflective practice is a process of reasoning that considers all aspects of the present situation, including practicalities, learning from personal practice, and consideration of patient needs. Patients appreciate care decisions made while considering their input. Involving the patient in their care provides the patient with a sense of contribution rather...
2.1K
Classification of Illness
7.6K
The meaning of illness is individualized to each person who experiences an alteration in health. In contrast, disease is a medical term indicating a pathological change in the structure and function of the body or mind. It is a condition that has specific symptoms and boundaries.
An illness is a response to a disease in which the person's level of functioning is changed compared with a previous level. The general classification of illness includes acute and chronic.
Acute illness is severe...
An illness is a response to a disease in which the person's level of functioning is changed compared with a previous level. The general classification of illness includes acute and chronic.
Acute illness is severe...
7.6K


