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home healthcare, machine learning, natural language process, predictive risk model, wound infection



  1. Song, Jiyoun PhD, RN, AGACNP-BC
  2. Woo, Kyungmi PhD, RN
  3. Shang, Jingjing PhD, RN
  4. Ojo, Marietta MPH
  5. Topaz, Maxim PhD, RN


OBJECTIVE: Wound infection is prevalent in home healthcare (HHC) and often leads to hospitalizations. However, none of the previous studies of wounds in HHC have used data from clinical notes. Therefore, the authors created a more accurate description of a patient's condition by extracting risk factors from clinical notes to build predictive models to identify a patient's risk of wound infection in HHC.


METHODS: The structured data (eg, standardized assessments) and unstructured information (eg, narrative-free text charting) were retrospectively reviewed for HHC patients with wounds who were served by a large HHC agency in 2014. Wound infection risk factors were identified through bivariate analysis and stepwise variable selection. Risk predictive performance of three machine learning models (logistic regression, random forest, and artificial neural network) was compared.


RESULTS: A total of 754 of 54,316 patients (1.39%) had a hospitalization or ED visit related to wound infection. In the bivariate logistic regression, language describing wound type in the patient's clinical notes was strongly associated with risk (odds ratio, 9.94; P < .05). The areas under the curve were 0.82 in logistic regression, 0.75 in random forest, and 0.78 in artificial neural network. Risk prediction performance of the models improved (by up to 13.2%) after adding risk factors extracted from clinical notes.


CONCLUSIONS: Logistic regression showed the best risk prediction performance in prediction of wound infection-related hospitalization or ED visits in HHC. The use of data extracted from clinical notes can improve the performance of risk prediction models.