在过渡到维持透析期间,电子健康记录中的症状轨迹
James B Wetmore1,2, Kirsten L Johansen1,2, David T Gilbertson2
1Division of Nephrology, Hennepin Healthcare and Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Clinical journal of the American Society of Nephrology : CJASN
|November 14, 2023
概括
在透析开始前的6个月内,疼痛和疲劳等症状会恶化. 透析开始与症状减轻有关,大多数症状在慢性脏病患者的启动后保持稳定.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 临床信息学 临床信息学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 症状负担显著影响慢性病 (CKD) 患者的生活质量.
- 过渡到透析是CKD患者的关键时刻,经常伴随症状变化.
- 了解透析开始时的症状轨迹对于患者的护理和管理至关重要.
研究的目的:
- 研究如何在晚期CKD患者的透析开始前后6个月内在电子健康记录 (EHR) 中记录关键症状的变化.
- 分析记录症状的时间模式,包括疼痛,疲劳/软弱,呼吸短促,恶心/吐和难以集中注意力.
主要方法:
- 利用Optum无标识的综合索赔-临床数据集,识别了728名CKD4或5期开始透析的患者.
- 使用自然语言处理 (NLP) 来从结构化临床笔记中提取症状数据.
- 应用中断时间序列分析与细分后勤回归来估计在透析开始前,期间和之后症状记录几率的变化.
主要成果:
- 在透析前,每周记录疼痛,疲劳/虚弱,呼吸短促,恶心/吐和难以集中注意力的几率都会增加.
- 开始透析与记录疼痛 (OR 0.70) 和疲劳/虚弱 (OR 0.62) 的几率立即降低有关.
- 透析后,症状记录率基本保持稳定,与透析前期相比,疼痛和疲劳/虚弱的轨迹有所改善.
结论:
- 患者报告的关键症状在透析开始之前的时间里显著增加频率.
- 开始透析会立即减少几种主要症状的记录.
- 症状负担,如EHR中反映的,通常在透析开始后稳定,这表明治疗的潜在益处.
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