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Approaches for classifying the indications for colonoscopy using detailed clinical data.

ABSTRACT: Accurate indication classification is critical for obtaining unbiased estimates of colonoscopy effectiveness and quality improvement efforts, but there is a dearth of published systematic classification approaches. The objective of this study was to evaluate the effects of data-source and adjudication on indication classification and on estimates of the effectiveness of screening colonoscopy on late-stage colorectal cancer diagnosis risk.This was an observational study in members of four U.S. health plans. Eligible persons (n = 1039) were age 55-85 and had been enrolled for 5 years or longer in their health plans during 2006-2008. Patients were selected based on late-stage colorectal cancer diagnosis in a case-control design; each case patient was matched to 1-2 controls by study site, age, sex, and health plan enrollment duration. Reasons for colonoscopies received in the 10-year period before the reference date were collected from three medical records sources (progress notes; referral notes; procedure reports) and categorized using an algorithm, with committee adjudication of some tests. We evaluated indication classification concordance before and after adjudication and used logistic regressions with the Wald Chi-square test to compare estimates of the effects of screening colonoscopy on late-stage colorectal cancer diagnosis risk for each of our data sources to the adjudicated indication.Classification agreement between each data-source and adjudication was 78.8-94.0% (weighted kappa = 0.53-0.72); the highest agreement (weighted kappa = 0.86-0.88) was when information from all data sources was considered together. The choice of data-source influenced the association between screening colonoscopy and late-stage colorectal cancer diagnosis; estimates based on progress notes were closest to those based on the adjudicated indication (% difference in regression coefficients = 2.4%, p-value = 0.98), as compared to estimates from only referral notes (% difference in coefficients = 34.9%, p-value = 0.12) or procedure reports (% difference in coefficients = 27.4%, p-value = 0.23).There was no single gold-standard source of information in medical records. The estimates of colonoscopy effectiveness from progress notes alone were the closest to estimates using adjudicated indications. Thus, the details in the medical records are necessary for accurate indication classification.

SUBMITTER: Fassil H

PROVIDER: S-EPMC3927818 | biostudies-other | 2014 Feb

REPOSITORIES: biostudies-other

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Approaches for classifying the indications for colonoscopy using detailed clinical data.

Fassil Hirut H Adams Kenneth F KF Weinmann Sheila S Doria-Rose V Paul VP Johnson Eric E Williams Andrew E AE Corley Douglas A DA Doubeni Chyke A CA

BMC cancer 20140215

<h4>Background</h4>Accurate indication classification is critical for obtaining unbiased estimates of colonoscopy effectiveness and quality improvement efforts, but there is a dearth of published systematic classification approaches. The objective of this study was to evaluate the effects of data-source and adjudication on indication classification and on estimates of the effectiveness of screening colonoscopy on late-stage colorectal cancer diagnosis risk.<h4>Methods</h4>This was an observation ...[more]

PMID: 24529031

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Project description:BackgroundAccurate determination of colonoscopy indication is required for managing clinical programs and performing research; however, existing algorithms that use available electronic databases (eg, diagnostic and procedure codes) have yielded limited accuracy.ObjectiveTo develop and validate an algorithm for classifying colonoscopy indication that uses comprehensive electronic medical data sources.DesignWe developed an algorithm for classifying colonoscopy indication by using commonly available electronic diagnostic, pathology, cancer, and laboratory test databases and validated its performance characteristics in comparison with a comprehensive review of patient medical records. We also evaluated the influence of each data source on the algorithm's performance characteristics.SettingKaiser Permanente Northern California healthcare system.PatientsA total of 300 patients who underwent colonoscopy between 2007 and 2010.InterventionsColonoscopy.Main outcome measurementsAlgorithm's sensitivity, specificity, and positive predictive value (PPV) for classifying screening, surveillance, and diagnostic colonoscopies. The reference standard was the indication assigned after comprehensive medical record review.ResultsFor screening indications, the algorithm's sensitivity was 88.5% (95% confidence interval [CI], 80.4%-91.7%), specificity was 91.7% (95% CI, 87.0%-95.1%), and PPV was 83.3% (95% CI, 74.7%-90.0%). For surveillance indications, the algorithm's sensitivity was 93.4% (95% CI, 86.2%-97.5%), specificity was 92.8% (95% CI, 88.4%-95.9%), and PPV was 85.0% (95% CI, 76.5%-91.4%). The algorithm's sensitivity, specificity, and PPV for diagnostic indications were 81.4% (95% CI, 73.0%-88.1%), 96.8% (95% CI, 93.2%-98.8%), and 93.9% (95% CI, 87.2%-97.7%), respectively.LimitationsValidation was confined to a single healthcare system.ConclusionAn algorithm that uses commonly available modern electronic medical data sources yielded a high sensitivity, specificity, and PPV for classifying screening, surveillance, and diagnostic colonoscopy indications. This algorithm had greater accuracy than the indication listed on the colonoscopy report.

Project description:BackgroundComputer-aided machine learning models are being actively developed with clinically available biomarkers to diagnose Alzheimer's disease (AD) in living persons. Despite considerable work with cross-sectional in vivo data, many models lack validation against postmortem AD neuropathological data.ObjectiveTrain machine learning models to classify the presence or absence of autopsy-confirmed severe AD neuropathology using clinically available features.MethodsAD neuropathological status are assessed at postmortem for participants from the National Alzheimer's Coordinating Center (NACC). Clinically available features are utilized, including demographics, Apolipoprotein E(APOE) genotype, and cortical thicknesses derived from ante-mortem MRI scans encompassing AD meta regions of interest (meta-ROI). Both logistic regression and random forest models are trained to identify linearly and nonlinearly separable features between participants with the presence (N = 91, age-at-MRI = 73.6±9.24, 38 women) or absence (N = 53, age-at-MRI = 68.93±19.69, 24 women) of severe AD neuropathology. The trained models are further validated in an external data set against in vivo amyloid biomarkers derived from PET imaging (amyloid-positive: N = 71, age-at-MRI = 74.17±6.37, 26 women; amyloid-negative: N = 73, age-at-MRI = 71.59±6.80, 41 women).ResultsOur models achieve a cross-validation accuracy of 84.03% in classifying the presence or absence of severe AD neuropathology, and an external-validation accuracy of 70.14% in classifying in vivo amyloid positivity status.ConclusionsOur models show that clinically accessible features, including APOE genotype and cortical thinning encompassing AD meta-ROIs, are able to classify both postmortem confirmed AD neuropathological status and in vivo amyloid status with reasonable accuracies. These results suggest the potential utility of AD meta-ROIs in determining AD neuropathological status in living persons.

Project description:Movement screens are frequently used to identify differences in movement patterns such as pathological abnormalities or skill related differences in sport; however, abnormalities are often visually detected by a human assessor resulting in poor reliability. Therefore, our previous research has focused on the development of an objective movement assessment tool to classify elite and novice athletes' kinematic data using machine learning algorithms. Classifying elite and novice athletes can be beneficial to objectively detect differences in movement patterns between the athletes, which can then be used to provide higher quality feedback to athletes and their coaches. Currently, the method requires optical motion capture, which is expensive and time-consuming to use, creating a barrier for adoption within industry. Therefore, the purpose of this study was to assess whether machine learning could classify athletes as elite or novice using data that can be collected easily and inexpensively in the field using inertial measurement units (IMUs). A secondary purpose of this study was to refine the architecture of the tool to optimize classification rates. Motion capture data from 542 athletes performing seven dynamic screening movements were analyzed. A principal component analysis (PCA)-based pattern recognition technique and machine learning algorithms with the Euclidean norm of the segment linear accelerations and angular velocities as inputs were used to classify athletes based on skill level. Depending on the movement, using metrics achievable with IMUs and a linear discriminant analysis (LDA), 75.1-84.7% of athletes were accurately classified as elite or novice. We have provided evidence that suggests our objective, data-driven method can detect meaningful differences during a movement screening battery when using data that can be collected using IMUs, thus providing a large methodological advance as these can be collected in the field using sensors. This method offers an objective, inexpensive tool that can be easily implemented in the field to potentially enhance screening, assessment, and rehabilitation in sport and clinical settings.

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Approaches for classifying the indications for colonoscopy using detailed clinical data.

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Approaches for classifying the indications for colonoscopy using detailed clinical data.

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