检查儿童医院再入院中的住房不安全和交通障碍:从结构化和非结构化数据的洞察力
Shivani Mehta1, William Brown1,2,3,4,5, Urmimala Sarkar2,6
1Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA 94158, United States.
Journal of the American Medical Informatics Association : JAMIA
|August 15, 2025
概括
结合结构化和非结构化数据显著改善了儿童健康的社会决定因素 (SDOH) 的识别,揭示了对医院再入院和急诊室访问的影响更大. 这种混合方法提高了针对性干预的风险评估.
科学领域:
- 儿科医疗保健研究的研究.
- 医疗信息学 医疗信息学
- 公共卫生 公共卫生
背景情况:
- 儿童医院的再入院费用昂贵,表明护理不足.
- 健康的社会决定因素 (SDOH),如住房和交通不安全,在儿童中至关重要,但研究不足.
- 识别SDOH对于改善儿科健康结果至关重要.
研究的目的:
- 评估与住房和交通相关的SDOH对儿科再接收的影响.
- 为了比较使用结构化ICD-10-CM Z代码与SDOH识别的混合方法 (结构化数据+自然语言处理) 的有效性.
- 评估SDOH和儿科患者再入院风险之间的关联.
主要方法:
- 对8928名从2018年1月至2023年1月出院的儿科患者 (2-17岁) 进行了回顾性队列研究.
- 使用结构化Z码和NLP提取的非结构化数据来确定SDOH暴露.
- 考克斯的比例危险模型用于分析SDOH和365天医院再入院风险之间的关联.
主要成果:
- 混合方法确定了31.7%的SDOH暴露患者,而仅仅使用结构化数据的患者仅为0.8%.
- 通过混合方法识别的患者的再接收风险 (HR: 2.64) 比仅通过结构化数据识别的患者 (HR: 1.99) 高.
- 在暴露患者中观察到更高的急诊室 (ED) 使用率,混合方法与ED再入院的相关性更强.
结论:
- 非结构化数据分析显著提高了儿童群体中SDOH的识别.
- 混合数据方法揭示了SDOH和医院/ED再入院之间的更强的关联.
- 通过混合数据分析改善风险分层,可以指导针对儿科健康差异的有针对性的干预措施.
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